Pupillary Pathways

Nip Those Spring Allergies in the Bud!

Posted by Amanda Dexter on Mar 28, 2016 9:23:26 AM
Amanda Dexter
Dr. Amanda K. Dexter received her optometric training at Southern California College of Optometry in Fullerton, California, where she was Class of 2010 Valedictorian. She also completed a residency in Primary Care and Ocular Disease at the Veteran's Affairs Hospital in San Diego, California. Dr. Dexter is the Manager and Program Coordinator for OptoPrep, the premiere online study resource for the NBEO Part I & II.

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Spring has officially begun which means that longer days, sunnier days, and days in which we will be spending more time outside are just around the corner!

Although I can’t wait for the warmer weather to ensue, there is one thing that I can do without during this season… ALLERGIES!

This is one of the worst times of year for red, itchy, scratchy, and watery eyes. You feel it, your patients feel it, I think my dog even feels it, and it’s not fun.

But the silver lining in this is that we really do have some great treatments available for helping ourselves and our patients manage eye allergy symptoms during these rough months.

Below are a few tips I’ve come up with to keep your eyes white, happy, and healthy to tackle those spring allergies.

Start Allergy Eyedrops Early

If your patient tells you that every year in April their ocular allergies start to flare up, get them started on treatment a few weeks earlier.  Proactive treatment that allows for mast cell stabilization and antihistamine effects to be working early on in the background will help them better fight the allergens come allergy season. 

Eyedrops.jpgEducate your patients on the allergic cascade so that they understand the importance of being prepared.  I like to tell them that allergic reactions can be similar to an avalanche.  At first it starts out as a trickle, and then all of a sudden you get bombarded with inflammatory factors causing redness, swelling, itching, and other uncomfortable symptoms. 

It is much easier for us to treat early, because after the allergic cascade (or avalanche) has started, there is much more to deal with and it is much more difficult to get the patient back on track.  They usually understand this and will follow my recommendations.

And if they don’t that year… they come back asking for early treatment next time! 

Prescription vs. Over-the-Counter Medications

Some prescription allergy medications can get pricey, even with insurance and manufacturer’s coupons. I’ve found recently that insurance companies will require a pre-authorization for certain allergy medications, which includes documentation that other less-expensive or over-the-counter medications have been tried and failed. 

Sometimes there is no way around it and you are left with trying over-the-counter medications for your patients. Although comfort, compliance and patient symptoms are often best managed with prescription drops, there are a couple of options for OTC medications that you should consider. 

I’m sure we can all agree that the best OTC allergy drops will be a mast-cell stabilizer and antihistamine combination medication. The antihistamine quickly relieves itching, while the mast-cell stabilizer prevents itching over an extended period of time.

This would include any drop with the active ingredient, ketotifen 0.025%. I would recommend either Zaditor (Novartis) or Alaway (Bausch + Lomb). These drops typically last for a period of about 12 hours, therefore they are dosed twice per day.

Even though these drops aren’t considered “prescription,” still write it out on a prescription pad for the patient so that they know exactly what to get when they head to the drugstore. If you don’t do this, they’ll likely end up with the most inexpensive, store-brand allergy medication and will be upset with you when they don’t work!

Other Palliative Treatments

I always tell my patients that in addition to the eyedrops, there are other ways to help with ocular allergy symptoms when the itching, redness, and swelling seem more severe. 

Cold compresses and icepacks are a great way to help reduce symptoms of itching, swelling and redness of the eyes and eyelids that is associated with allergies. Cold stabilizes mast cells and causes vasoconstriction. 

Another trick that I tell my patients is to keep a bottle of artificial tears in the refrigerator. Not only do artificial tears help by diluting the antigen in the tears, cold tears really give a soothing feeling when allergy symptoms are in full effect.

Remember that a lot of these patients have other allergy symptoms, such as allergic rhinitis and hives, and are typically taking an oral allergy medication that can lead to concurrent dry eye symptoms. It is important that you allergy patients are also using artificial tears throughout the day. 

I also remind my patients to be sure to wear their sunglasses outdoors! This is a super easy way to simply reduce direct ocular exposure to airborne allergens when spending time outside. 

Consider Steroid Drops 

Patients who present with more severe allergic disease may often need a short-term course of a soft steroid.  Don’t be afraid to prescribe something like Alrex (loteprednol etabonate 0.2%) when treating allergic conjunctivitis. This drop is specifically approved for the management for seasonal allergic conjunctivitis and is extremely effective and provides a very low incidence of steroid adverse effects. 

The key here to appropriate management of allergy signs and symptoms is to tailor treatment to the individual. Start simple, and start early, but don’t be afraid to be aggressive if the presentation demands it!

-Dr. Dexter 

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Topics: Allergies