Big guns for big allergies

With the allergy season in full swing, pollen, dust, spores and other allergens make life miserable for the eyes, sinuses and noses of allergy sufferers. As I have spoken about previously, good hygiene around the eyes is essential to reduce the suffering of the season. For many patients keeping the eyes well irrigated with artificial tears and careful and frequent washing of the face and hands is the best and easiest therapy when allergies kick up. But for an equal number of patients this simply is not adequate. When this is the case we turn to our arsenal of prescription medicines and eye drops. Both oral and topical medicines are quite effective at controlling the signs and symptoms of allergic conjunctivitis. The oral medicines are somewhat less effective in treating eye related allergies but, controlling the congestion of the nasal and sinus passages goes a long way in bringing generalized relief to the allergy sufferer.

Not including artificial tears and over-the-counter eye drops, there are over two dozen prescription products available to control allergic eye disease. From steroid based eye drops to non-steroidal and immunosuppressive eye drops there are many options available to the eye physician for patients suffering from allergies. Many medications when used in conjunction with good ocular hygiene are adequate by themselves in controlling the allergy problem. Many times it is necessary to prescribe two medications that have different mechanisms of action to get maximum control and comfort for the patient. Once that is accomplished, one or the other eye drops can be discontinued or only used as needed for flare-ups. Finally, some patients require more than one medication continually during the allergy season to ensure adequate control and comfort. To make things just a little more complicated dry eye patients require additional therapy to lubricate the eyes. Sound pretty confusing? Well it can be because no one therapy fits all patients.

Let’s talk briefly about the different classes of allergy drops. The oldest group is the steroid class. These eye drops are very effective at reducing the inflammation in allergy affected eyes. They do have side effects (such as glaucoma and cataract formation) and long-term use is certainly not recommended. Some of the newer types of steroids are much safer to use long term but the patient should still have routine monitoring exams while taking them. Another older class is the non-steroidal anti-inflammatory eye drop. These are the ibuprofens of eye drops. They also work to reduce inflammation and have many fewer risks than the steroids. There have been many advances in the past few years with more effective non-steroidals being available today.

The most effective classes of drops are the immunosuppressive and mast cell stabilizers. These medications actually work at the cause of the allergic reaction. White blood cells called mast cells arriving to fight allergens in the eye release chemicals called histamines that causes the eyes to turn red, itch, swell, water and otherwise feel miserable. These classes of eye drops actually stabilize the mast cell membrane so that it cannot release as much histamine and the allergic reaction is controlled. To be totally effective these drops must be taken continually during the allergy season even if the eyes feel 100%. Remember these drops prevent a reaction so they must be there whenever the eye is assaulted by allergens. This is kind of like the policeman or National Guard of the eye. As long as they are doing their job we are safe from the affects of allergies.

By using these medications as directed by your eye physician and by careful hygiene and good lubrication the allergy season can be more of an annoyance than a handicap. Of course, if this all fails, you could always consider a move to the frozen tundra of Alaska or the desert islands of the Pacific Ocean where allergies are rare or even absent year around.

If you have questions about your eye health e-mail Dr. Barowsky at and we’ll try to answer your questions here at Eye-Q.