Got the Itchies?
I’m sure I could have used a safer title for my maiden post – we’re talking about itchy EYES here, folks!
As I was driving with my wife and two boys the other day, Cindy pointed out that bits of green were starting to appear on the fields that we passed. This, along with my newfound congestion and increased patient demand for antihistamine prescriptions, has provided a nice reminder that Spring officially starts this Saturday with the Vernal Equinox!
I recently read an interesting article that changed the way I think about allergy treatment, as it pertains to itchy eyes and nasal congestion. Traditionally, if a patient complains of itchy eyes I will ask them if they have other associated symptoms – nasal congestion being the most common. If they DO have other symptoms, I figure we can just take care of everything all at once with an antihistamine pill. Easy enough, right? One treatment for multiple symptoms, no eye drops for people to mess with, often available over-the-counter.
What this article brings up, however, is the fact that oral antihistamines are one of the worst pharmacologic contributors to dry eye disease. So, by attempting to treat one type of eye discomfort, we’re likely causing another – this is especially salient knowledge for contact lens wearers, who often are affected by ocular dryness. Topical medication is also sure to result in a higher tissue concentration in the affected area than a general systemic med taken orally – this is true not only for allergy eye drops, but also for allergy nasal sprays. With combination treatment of an eye drop – which generally only requires once daily dosing – and a nasal spray, allergy symptoms are controlled without inducing dry eyes or any other potential side effects elsewhere in the body.
Other points to consider regarding eye allergies: people who wear (soft) contact lenses AND suffer from allergies are in a tricky situation, because their lenses will accumulate allergens over the life of the lens. As such, Daily Disposable contacts are really the best option for these choice individuals, to give a fresh, clean lens every day.
If eye allergies are left untreated, they can become serious enough that a simple antihistamine drop won’t “put out the fire.” In these cases, a short-term steroid drop will often be much more effective, with a general plan to transition to an antihistamine drop for long-term symptom control.
Although it may seem obvious, I will say it anyway: all of these eye conditions and treatments are best managed by your EYE care provider! I am constantly amazed at how many of my patients come in with acute eye problems that did not go away with the drops their family doctor gave them. With all due respect to general physicians, I would guess their expertise in eyes just about rivals my expertise in ear infections. Please let your optometrist give you the excellent care we were trained to give!