Optometry in Focus: Ocular Allergies

Happy Friday y’all!

First things first: how many of you haveseasonal allergies?

If you’re anything like me, (especially when residing in Texas) allergy season has come to include every month of the year.  Interestingly, while most people are aware of the effects of allergies on their sinuses, I find that many people are unaware of how allergies affect their eyes.

Insert today’s post!  Let’s get started!

Ocular Allergies

Causes

Pretty much all allergic reactions in the body have the same basic cause: the body identifies something (an antigen) as a foreign entity, and decides to attack it.  Allergies specifically are associated with a Type 1 Hypersensitivity reaction, mediated by the specific antibody Ig-E.  In this, the Ig-E antibody that is specific for the antigen that you’re allergic to (ie pollen, dander, etc) binds to an immune cell called the mast cell, which contains products that are meant to destroy or remove the antigen.
The most prominent product in mast cells is histamine.  This chemical causes all the typical allergy symptoms – a runny nose, watery eyes, and itching!

Symptoms

The most common symptoms of ocular allergies (as could probably be guessed from above) are:
  • Watery eyes
  • Itchy eyes
  • Swelling
  • Mild discharge
  • Blurred vision
Some additional signs of ocular allergies are:
  • Redness (generally in both eyes)
  • Papillae (little red bumps on the inside of your eyelids)

Treatment

Ocular allergies are treated much in the same way that systemic seasonal allergies are treated.
The first course of action is to remove the offending agent – aka, stay away from  what you’re allergic to!
However, when you’re allergic to the air in the entire state, that’s hard to do.
The second step is to take systemic allergy medications.  More often than not, these can be over the counter.  However, if your allergies are severe, you may need stronger, prescription medications.  If possible, try to stay away from decongestants though, as they can cause dryness and increase ocular irritation.
In the case of ocular allergies, it is often necessary to specifically treat the eyes.  I most commonly advocate for the use of over the counter eye drops before proceeding to prescription mediations.  My favorite drop is Pataday (olopatidine 0.2%), as it is relatively cost effective and only needs to be used once a day!  Other great the counter option are Zaditor and Alaway (both are ketotifen 0.035%), which are used twice a day.  Make sure to wait 5 minutes after using your drops to put in contact lenses or using any other drops.
As ocular allergies may be exacerbated by longer contact lens replacement schedules, I tend to prefer to fit patients with symptomatic ocular allergies in daily lenses.  This reduces the potential for buildup on lenses, and therefore decreases the likelihood of an allergic response.
Symptoms may also be mitigated by strategic hygienic considerations, such as showering in the evening and frequently washing pillowcases to reduce the number of potential allergens around the eyes while sleeping.
Finally, cool compresses are often helpful in reducing the itch that accompanies ocular allergies!
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