EyeWorld Asia-Pacific June 2017 Issue

66 EWAP PHARMACEUTICALS June 2017 ‘Tis the season for allergies by Maxine Lipner EyeWorld Senior Contributing Writer Gearing up for springtime ocular allergies I t’s par for the course: As certain vegetation begins to bloom, patients arrive rife with complaints of ocular allergy. When handling seasonal allergy patients, here’s the latest on what to keep in mind. To begin, you must ascertain what is happening in the eye, according to Mark Abelson, MD , clinical professor of ophthalmology, Harvard Medical School, and emeritus surgeon, Massachusetts Eye and Ear, Boston. “I call it Abelson’s law,” he said. “If it itches, it’s allergy. If it burns, it’s dry eye. And if it sticks in the morning, it’s bacterial.” There are also clinical signs, Dr. Abelson points out. “If it’s seasonal allergic, the eye is sort of very pale red,” he said, adding that if it’s fire engine red, then it’s another disease. Also, when you look at the eye in a slit lamp, there will possibly be some tearing, and eyelid and conjunctival swelling,” Dr. Abelson continued. “However, itching is the key—when we get drugs approved, they’re approved for itching and/or redness,” he said. Ira J. Udell, MD , Arlene and Arthur Levine, professor and chair, Department of Ophthalmology, Hofstra Northwell School of Medicine, chairman department of ophthalmology, Long Island Jewish Medical Center and Northshore University Hospital, Northwell Health System, Hempstead, New York, stresses the importance of taking a good history. “You want to know whether it tends to be seasonal,” Dr. Udell said. “Or, does it tend to occur throughout the year?” You also want to determine if they have any history of atopic disease such as eczema, he continued, adding that in the vast majority of cases, if you get the history correct and you know their symptoms, then you have pretty good idea of what you’re dealing with even before you examine them. Michael B. Raizman, MD , Ophthalmic Consultants of Boston, and director of cornea and cataract service, New England Eye Center, Tufts University School of Medicine, Boston, agrees that the history is very important. “In general, allergy is not difficult to diagnose— almost always itching is a primary symptom,” Dr. Raizman said. “Occasionally, this can be confusing because some patients use the word itching differently than the doctor might.” However, if you’re specific in your questioning, you can usually elicit some symptoms of itching, he continued, stressing, however, that if there’s no itching, it’s not allergy. Also, just because the eyes may appear clear on the day that you examine the patient does not mean that it’s not allergy. “Some patients with rather severe ocular allergies may have their good days and bad days, and their eyes may look perfect the day that you see them, but they’re actually quite bothered by allergy,” Dr. Raizman said. “You can’t always go by the exam—the history is especially important.” There are also some tests that may prove helpful in determining what antigen a patient may be allergic to. Traditional skin testing, RAST testing of blood, and in-office testing, such as the Doctor’s Allergy Formula (Norcross, Georgia), are options, he noted. Testing, Dr. Raizman said, often helps with education to let patients know what they’re allergic to so that they have a better understanding of what they need to avoid. In addition, he finds that the Tear Scan MicroAssay System for IgE (Advanced Tear Diagnostics, Raleigh, North Carolina) can be helpful. This measures immunoglobulin E (IgE) in the tear film, and along with other tests that are under development, will be helpful in giving a more objective way in determining whether allergy is an issue, Dr. Raizman noted. “I think it makes it more concrete for the patient,” he said. “It sort of validates what you’re saying as a doctor, and I think makes the patient more compliant with your instructions.” Dr. Abelson, however, views such testing as extraneous. “By the time they come to an ophthalmologist, if they’re coming in season, then we know,” he said, adding that if they come in ragweed season, it’s likely ragweed, and if they’re in Arizona and the cactus is blooming, that’s probably the cause—not the cat. However, if symptoms are year-round, that is a different story. It is probably a good idea to identify which allergens are causing the reaction. OTC possibilities Remedies can begin with something as simple as a cold compress or artificial tears, according to Paul Gomes , head of the largest clinical research group in ocular allergy at ORA (Andover, Massachusetts). Cold compresses quiet the eye, make it feel better, and also reduce redness and swelling. Meanwhile, artificial tears help to dilute and wash out pollens and the mediators that are released in the tears, he continued. Dr. Raizman likewise believes that there is a role for artificial tears in the management of ocular allergy. These help patients with comfort, he points out, adding that this is especially true if you chill them. “I sometimes tell patients to keep a bottle of tears in the refrigerator at home or at work and then when you put a Seasonal allergic conjunctivitis Source: Ira J. Udell, MD