Calming allergic conjunctivitis
Ocular allergies
Calming allergic conjunctivitis
A patient with SAC Source: Ira J. Udell, M.D.
April showers bring May flowers and endless misery to those suffering from seasonal and perennial conjunctivitis caused by pollen, mold, and grasses. 'Tis the season for red, itchy eyes, so EyeWorld spoke with two experts about diagnosing and treating patients with these ocular issues.
Seasonal or perennial?
The differences between seasonal and perennial allergies are limited, said Leonard Bielory, M.D., Springfield, N.J. Other than their frequency, primary differences are severity of symptoms and root cause. Seasonal allergies occur during the spring and fall months and are typically caused by pollen, grass, and ragweed. The intensity of seasonal allergic conjunctivitis (SAC) can be explosive for a number of weeks, depending on the level of exposure to the specific allergen circulating. "Tree pollen counts can go up into the thousands in Washington, D.C., and 47% of it is oak pollen," Dr. Bielory said. "In the Northeast, from Delaware up through Connecticut and hitting Boston, birch pollen is the highest pollinator into the thousands of cubic meters." Perennial allergic conjunctivitis (PAC) is chronic and, as its name suggests, isn't limited to certain months. Many people with PAC are literally sleeping under a roof of allergens with a house full of pet dander, dust, or mold shelling their system and causing a chronic condition. Signs of SAC and PAC are, however, the same. "The symptoms are basically itching, irritation, burning, a sandy sensation, and red eyes," said Ira J. Udell, M.D., chair, ophthalmology department, North Shore-LIJ Health System, New York. "For the most part, the redness is more of a pinkness than an intense redness. If you see an intensely red eye, you have to be thinking of other diagnoses."
Make sure it's allergies
Just because patients present in your office with conjunctivitis during suspect months doesn't mean their roblems are allergy related. There are many causes of conjunctivitis, and because certain kinds are highly infectious it's important to distinguish between them. For example, be suspicious if an adult patient comes in with conjunctivitis and does not have a history of allergies. Pay attention to the redness. Allergic conjunctivitis is pinkish while viral conjunctivitis can be an intense red. Patients with viral cases may also get little petechial hemorrhages in the conjunctiva, Dr. Udell said. Occasionally patients will have some itching, but not much. If patients do have viral conjunctivitis, you'll want to isolate them for about 2 weeks. "There are some very mild viral conjunctivitis that may look like an acute allergic reaction, but what generally differentiates them is the itching," Dr. Udell said. "If you see itching or hear about itching, think more of an allergic process."
Episcleritis, however, is an exception to that rule. It's characterized by itching, inflammation of the surface layer of the sclera, and eye redness. "What generally differentiates [episcleritis] in most patients is it's in one eye or in more of one eye than the other," Dr. Udell said. "It may be in a sector of the eye where only part of the eye is red. So if you see anything sectorial, that's not generally going to be allergic."
SAC and PAC treatments
Avoidance is the first line of defense against ocular allergies, Dr. Bielory said. "Secondary treatments are lubrication and washing the eye out upon exposure," he said. "There is literature to support that disposable contact lenses improve ocular allergies. If you can get rid of those contact lenses that are loaded with pollen from the week before that you're allergic to, you'll decrease the allergic triggers associated with the reaction on the conjunctiva surface."
A topical decongestant with or without an antihistamine is another option. This will decrease redness but won't affect itching. Allergy shots can be helpful for patients with both ocular and nasal symptoms, but won't improve ocular allergies alone. "What I generally do is cut to the chase," Dr. Udell said. "If patients come in and their symptoms are moderately severe, you can use artificial tears and those things, but it's not going to give them much relief. I would move right to the combination agent, which is a topical antihistamine and mast cell stabilizer. "The nice thing about the combination is it helps stabilize the membrane so there's less release of mediators," Dr. Udell continued. "For the histamine that's released, which is one of the main culprits of ocular allergy, it will help block the receptors from causing some of the irritating symptoms." For severe cases, an over-the-counter vasoconstrictor antihistamine can be extremely effective, but Dr. Udell warns this is temporary and should only be used occasionally for a short duration. Overuse can lead to rebound redness. Topical steroids for SAC and PAC are another option, albeit a controversial one. Dr. Bielory and Udell recommended them for extreme situations in a burst of therapy, but said steroids are unnecessary for minor to moderate cases. "There's a risk of raising intraocular pressure, and if [patients] take it for prolonged periods of time, [they] may get a cataract," Dr. Udell said. EW
Editors' note: The doctors mentioned have no financial interests related to this article.
Contact information
Bielory: drlbielory@gmail.com
Udell: ijudell@aol.com
Calming allergic conjunctivitis
by Faith A. Hayden EyeWorld Staff Writer
April showers bring May flowers and endless misery to those suffering from seasonal and perennial conjunctivitis caused by pollen, mold, and grasses. 'Tis the season for red, itchy eyes, so EyeWorld spoke with two experts about diagnosing and treating patients with these ocular issues.
Seasonal or perennial?
The differences between seasonal and perennial allergies are limited, said Leonard Bielory, M.D., Springfield, N.J. Other than their frequency, primary differences are severity of symptoms and root cause. Seasonal allergies occur during the spring and fall months and are typically caused by pollen, grass, and ragweed. The intensity of seasonal allergic conjunctivitis (SAC) can be explosive for a number of weeks, depending on the level of exposure to the specific allergen circulating. "Tree pollen counts can go up into the thousands in Washington, D.C., and 47% of it is oak pollen," Dr. Bielory said. "In the Northeast, from Delaware up through Connecticut and hitting Boston, birch pollen is the highest pollinator into the thousands of cubic meters." Perennial allergic conjunctivitis (PAC) is chronic and, as its name suggests, isn't limited to certain months. Many people with PAC are literally sleeping under a roof of allergens with a house full of pet dander, dust, or mold shelling their system and causing a chronic condition. Signs of SAC and PAC are, however, the same. "The symptoms are basically itching, irritation, burning, a sandy sensation, and red eyes," said Ira J. Udell, M.D., chair, ophthalmology department, North Shore-LIJ Health System, New York. "For the most part, the redness is more of a pinkness than an intense redness. If you see an intensely red eye, you have to be thinking of other diagnoses."
Make sure it's allergies
Just because patients present in your office with conjunctivitis during suspect months doesn't mean their roblems are allergy related. There are many causes of conjunctivitis, and because certain kinds are highly infectious it's important to distinguish between them. For example, be suspicious if an adult patient comes in with conjunctivitis and does not have a history of allergies. Pay attention to the redness. Allergic conjunctivitis is pinkish while viral conjunctivitis can be an intense red. Patients with viral cases may also get little petechial hemorrhages in the conjunctiva, Dr. Udell said. Occasionally patients will have some itching, but not much. If patients do have viral conjunctivitis, you'll want to isolate them for about 2 weeks. "There are some very mild viral conjunctivitis that may look like an acute allergic reaction, but what generally differentiates them is the itching," Dr. Udell said. "If you see itching or hear about itching, think more of an allergic process."
Episcleritis, however, is an exception to that rule. It's characterized by itching, inflammation of the surface layer of the sclera, and eye redness. "What generally differentiates [episcleritis] in most patients is it's in one eye or in more of one eye than the other," Dr. Udell said. "It may be in a sector of the eye where only part of the eye is red. So if you see anything sectorial, that's not generally going to be allergic."
SAC and PAC treatments
Avoidance is the first line of defense against ocular allergies, Dr. Bielory said. "Secondary treatments are lubrication and washing the eye out upon exposure," he said. "There is literature to support that disposable contact lenses improve ocular allergies. If you can get rid of those contact lenses that are loaded with pollen from the week before that you're allergic to, you'll decrease the allergic triggers associated with the reaction on the conjunctiva surface."
A topical decongestant with or without an antihistamine is another option. This will decrease redness but won't affect itching. Allergy shots can be helpful for patients with both ocular and nasal symptoms, but won't improve ocular allergies alone. "What I generally do is cut to the chase," Dr. Udell said. "If patients come in and their symptoms are moderately severe, you can use artificial tears and those things, but it's not going to give them much relief. I would move right to the combination agent, which is a topical antihistamine and mast cell stabilizer. "The nice thing about the combination is it helps stabilize the membrane so there's less release of mediators," Dr. Udell continued. "For the histamine that's released, which is one of the main culprits of ocular allergy, it will help block the receptors from causing some of the irritating symptoms." For severe cases, an over-the-counter vasoconstrictor antihistamine can be extremely effective, but Dr. Udell warns this is temporary and should only be used occasionally for a short duration. Overuse can lead to rebound redness. Topical steroids for SAC and PAC are another option, albeit a controversial one. Dr. Bielory and Udell recommended them for extreme situations in a burst of therapy, but said steroids are unnecessary for minor to moderate cases. "There's a risk of raising intraocular pressure, and if [patients] take it for prolonged periods of time, [they] may get a cataract," Dr. Udell said. EW
Editors' note: The doctors mentioned have no financial interests related to this article.
Contact information
Bielory: drlbielory@gmail.com
Udell: ijudell@aol.com
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