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Suggest Remedies For Ocular Allergies
Question: I have had very severe ocular allergies during spring for the better part of 20 years. Where I live in the USA I can almost not spend any time outdoors from the middle of March until early to middle May. It's really a huge inconvenience and nuisance not to mention quite painful. I've seen allergists and eye doctors over the years trying every new eye allergy drops that hit the market and none of it seems to help much. The only relief I get is if I take steroids but that's not practical to take all the time and I don't like how they make me feel. Do you have any recommendations? Is there anything I can try or any more recent breakthroughs to help with this problem for these two months out of the year? Thank you.
Brief Answer:
Please provide more details and allergy reports
Detailed Answer:
Hello XXXXXXX
Thank you for asking at HCM. I went through your history and understand your concern. I agree that ocular allergies cause much irritation and discomfort.
I would like to know more about your problem to make better suggestions. Please provide further details as asked below:
a. If you have problem in outdoors and for two months, I would suspect pollen allergy first. Can you please attach your allergy testing report?
b. I would like to know which drops you use and how you use them. Please mention any other drugs as well that you might be using.
c. What are your eye symptoms exactly - itching, redness, watering, swelling, sticking of eyelids, discharge? What is the diagnosis made by your ophthalmologist? (There are many types of ocular allergic disorders)
d. When you have ocular symptoms, do you have nose symptoms - sneezing, nasal itching, watery nasal discharge, nasal congestion, etc?
e. I would like to know more about allergy shots (allergen specific immunotherapy). I would like to know how frequently you received them, against which allergens, how was the response, etc.
f. Have you received any supplements till date?
g. How do you protect your eyes while going outdoors during the bad season?
i. I guess your digestion must be very good with no complaints. However, please mention if you have any problem related to digestion - acidity, constipation, indigestion, etc. Also please mention if you have observed that any particular food would aggravate your allergy symptoms.
At present, I would like to mention that seasonal allergies are best managed with ocular drops, some oral drugs, and allergen specific immunotherapy (allergy shots) - when used them appropriately.
Allergen avoidance is very important, but I agree that in case of pollen allergies, it is not always practical to stay indoors in order to avoid pollens.
Wish you best of the health ahead.
Regards,
Dr Parin N Parmar
Please provide more details and allergy reports
Detailed Answer:
Hello XXXXXXX
Thank you for asking at HCM. I went through your history and understand your concern. I agree that ocular allergies cause much irritation and discomfort.
I would like to know more about your problem to make better suggestions. Please provide further details as asked below:
a. If you have problem in outdoors and for two months, I would suspect pollen allergy first. Can you please attach your allergy testing report?
b. I would like to know which drops you use and how you use them. Please mention any other drugs as well that you might be using.
c. What are your eye symptoms exactly - itching, redness, watering, swelling, sticking of eyelids, discharge? What is the diagnosis made by your ophthalmologist? (There are many types of ocular allergic disorders)
d. When you have ocular symptoms, do you have nose symptoms - sneezing, nasal itching, watery nasal discharge, nasal congestion, etc?
e. I would like to know more about allergy shots (allergen specific immunotherapy). I would like to know how frequently you received them, against which allergens, how was the response, etc.
f. Have you received any supplements till date?
g. How do you protect your eyes while going outdoors during the bad season?
i. I guess your digestion must be very good with no complaints. However, please mention if you have any problem related to digestion - acidity, constipation, indigestion, etc. Also please mention if you have observed that any particular food would aggravate your allergy symptoms.
At present, I would like to mention that seasonal allergies are best managed with ocular drops, some oral drugs, and allergen specific immunotherapy (allergy shots) - when used them appropriately.
Allergen avoidance is very important, but I agree that in case of pollen allergies, it is not always practical to stay indoors in order to avoid pollens.
Wish you best of the health ahead.
Regards,
Dr Parin N Parmar
Above answer was peer-reviewed by :
Dr. Nagamani Ng
- I’d have to locate my last report. Not sure where to get my hands on it.
- It’s definitely a pollen allergy. When pollination season is over my ocular symptoms disappear and don't return until the next spring.
- I don’t recall all the names of the drops I’ve tried in the past but I’ve definitely tried Zaditor, several other prescription drops and virtually every OTC drop.
- Symptoms are all the ones you listed and they are rather severe if I spend any time outside during those two months. The worst symptom is the sensation that I have something like grains of sand in my eye. I don’t specifically recall the name my eye doctor gave to this. The closest description I can find on the internet to my symptoms is Giant papillary conjunctivitis.
- I do have nasal drip when I have the ocular problems which I control with Flonase.
- I was taking weekly shots for almost two years. It wasn’t helping so I gave up. I had one bad reaction after getting an allergy shot. Breathing was impaired. I was admitted and given a shot and breathing treatment. I was fine after that.
- What is a supplemental? Follow up shot? If so, no.
- I protect my eyes with glasses as best I can. I thought of using swim goggles but never did it.
- No digestion problems whatsoever
- It’s definitely a pollen allergy. When pollination season is over my ocular symptoms disappear and don't return until the next spring.
- I don’t recall all the names of the drops I’ve tried in the past but I’ve definitely tried Zaditor, several other prescription drops and virtually every OTC drop.
- Symptoms are all the ones you listed and they are rather severe if I spend any time outside during those two months. The worst symptom is the sensation that I have something like grains of sand in my eye. I don’t specifically recall the name my eye doctor gave to this. The closest description I can find on the internet to my symptoms is Giant papillary conjunctivitis.
- I do have nasal drip when I have the ocular problems which I control with Flonase.
- I was taking weekly shots for almost two years. It wasn’t helping so I gave up. I had one bad reaction after getting an allergy shot. Breathing was impaired. I was admitted and given a shot and breathing treatment. I was fine after that.
- What is a supplemental? Follow up shot? If so, no.
- I protect my eyes with glasses as best I can. I thought of using swim goggles but never did it.
- No digestion problems whatsoever
Brief Answer:
Diagnosis very important, options discussed
Detailed Answer:
Hello XXXXXXX
Thank you for the follow up and providing the details. Based on your details, I would like to make suggestions for you as follows:
1. First of all, name of the condition is important as there are many types of eye allergies - seasonal allergic conjunctivitis, vernal keratoconjunctivitis, giant papillary conjunctivitis, etc. All of them have nearly similar symptoms with some differences, but the treatment and prognosis definitely differ.
Some of them may involve cornea (the black part of the eye) in future, and hence making a correct diagnosis is very important. If you have not seen your ophthalmologist for many years, I would definitely suggest you see your ophthalmologist for this purpose. Your exact and correct treatment would depend upon the exact diagnosis.
2. Zaditor eye drops contain ketotifen, which does help, but there are some eye drops that may not be available as OTC. For example, I would suggest my patient with similar complaints by suggesting using olopatadine eye drops. I am not sure whether these are available in your region as OTC.
Olopatadine eye drops have better effects than ketotifen in eye allergies and and are relatively safe.
3. If olopatadine eye drops do not help, there are other options, which would be prescribed by an ophthalmologist only.
4. In addition to medicated drops, use of artificial tear drops is very important. They are usually safe and help reduce symptoms, reduce medication requirement, and wash out pollens/allergens that have entered conjunctiva.
Hence, I suggest my patients with ocular allergies to use artificial tear drops 3-4 times during day, during the pollen season. Washing eyes regularly with sterile cool water also helps.
5. Allergic rhinitis (nose symptoms of allergy) is often closely connected with ocular allergies. I would suggest my such patients to use inhaled corticosteroids (as you already do) for treatment of allergic rhinitis.
Alternative option is, if nose symptoms are not severe, to use montelukast and an antihistamine (such as cetirizine, levocetirizine, fexofenadine) during the pollen season.
Montelukast also helps to prevent some symptoms, if started 2 weeks before season and continued upto 1 week past the season is over.
6. Avoidance of non-specific irritants - smokes, pollution, sunlight - is important and should be emphasized. I would suggest you to use personal protection device (such as goggles which would protect from bright sunlight as well) to reduce entry of pollens and other irritants into eyes.
7. Deciding about allergy shots (allergen specific immunotherapy) depends upon the exact diagnosis of the eye disorder and allergy testing report. If you have a reaction to allergy shots, sublingual drops (drops to be kept under tongue) are also available, which are less likely to cause reactions than injections.
For seasonal allergies, pre-seasonal and co-seasonal immunotherapy is also possible, when you receive the drops/shots a few weeks before season and they are to be continued during the season. But they are not to be taken all the year.
I would suggest these options with your allergist.
8. By supplements, I mean vitamins. I usually suggest my allergic patients to take a good multivitamin-multimineral supplement, especially vitamin D and anti-oxidants to help immunity function better.
As there are ~6 weeks to go for the bad season for you, you are very well on time to decide about these options, including preseasonal immunotherapy and montelukast. Hence, please discuss these options with your doctor.
Hope above suggestions will be helpful to you. Should you have any further query, please feel free to ask on follow-up.
Wish you best of the health ahead.
Thank you & regards,
Dr Parin N Parmar
Diagnosis very important, options discussed
Detailed Answer:
Hello XXXXXXX
Thank you for the follow up and providing the details. Based on your details, I would like to make suggestions for you as follows:
1. First of all, name of the condition is important as there are many types of eye allergies - seasonal allergic conjunctivitis, vernal keratoconjunctivitis, giant papillary conjunctivitis, etc. All of them have nearly similar symptoms with some differences, but the treatment and prognosis definitely differ.
Some of them may involve cornea (the black part of the eye) in future, and hence making a correct diagnosis is very important. If you have not seen your ophthalmologist for many years, I would definitely suggest you see your ophthalmologist for this purpose. Your exact and correct treatment would depend upon the exact diagnosis.
2. Zaditor eye drops contain ketotifen, which does help, but there are some eye drops that may not be available as OTC. For example, I would suggest my patient with similar complaints by suggesting using olopatadine eye drops. I am not sure whether these are available in your region as OTC.
Olopatadine eye drops have better effects than ketotifen in eye allergies and and are relatively safe.
3. If olopatadine eye drops do not help, there are other options, which would be prescribed by an ophthalmologist only.
4. In addition to medicated drops, use of artificial tear drops is very important. They are usually safe and help reduce symptoms, reduce medication requirement, and wash out pollens/allergens that have entered conjunctiva.
Hence, I suggest my patients with ocular allergies to use artificial tear drops 3-4 times during day, during the pollen season. Washing eyes regularly with sterile cool water also helps.
5. Allergic rhinitis (nose symptoms of allergy) is often closely connected with ocular allergies. I would suggest my such patients to use inhaled corticosteroids (as you already do) for treatment of allergic rhinitis.
Alternative option is, if nose symptoms are not severe, to use montelukast and an antihistamine (such as cetirizine, levocetirizine, fexofenadine) during the pollen season.
Montelukast also helps to prevent some symptoms, if started 2 weeks before season and continued upto 1 week past the season is over.
6. Avoidance of non-specific irritants - smokes, pollution, sunlight - is important and should be emphasized. I would suggest you to use personal protection device (such as goggles which would protect from bright sunlight as well) to reduce entry of pollens and other irritants into eyes.
7. Deciding about allergy shots (allergen specific immunotherapy) depends upon the exact diagnosis of the eye disorder and allergy testing report. If you have a reaction to allergy shots, sublingual drops (drops to be kept under tongue) are also available, which are less likely to cause reactions than injections.
For seasonal allergies, pre-seasonal and co-seasonal immunotherapy is also possible, when you receive the drops/shots a few weeks before season and they are to be continued during the season. But they are not to be taken all the year.
I would suggest these options with your allergist.
8. By supplements, I mean vitamins. I usually suggest my allergic patients to take a good multivitamin-multimineral supplement, especially vitamin D and anti-oxidants to help immunity function better.
As there are ~6 weeks to go for the bad season for you, you are very well on time to decide about these options, including preseasonal immunotherapy and montelukast. Hence, please discuss these options with your doctor.
Hope above suggestions will be helpful to you. Should you have any further query, please feel free to ask on follow-up.
Wish you best of the health ahead.
Thank you & regards,
Dr Parin N Parmar
Above answer was peer-reviewed by :
Dr. Nagamani Ng
I'll make an appointment with my ophthalmologist to get an official and specific diagnosis, look into the artificial tears and look into starting a regimen of supplements for now. Thanks.
Brief Answer:
Sure.. Wish you best of health...
Detailed Answer:
Hello XXXXXXX
Thank you for reply.
Sure, that will help you and also will help you to get some medications/eye drops which may be available on prescription only.
If you have no further query, you can please close the question and give a feedback.
Wish you best of the health ahead.
Thank you & best regards,
Dr Parin N Parmar
Sure.. Wish you best of health...
Detailed Answer:
Hello XXXXXXX
Thank you for reply.
Sure, that will help you and also will help you to get some medications/eye drops which may be available on prescription only.
If you have no further query, you can please close the question and give a feedback.
Wish you best of the health ahead.
Thank you & best regards,
Dr Parin N Parmar
Note: For further information on diet changes to reduce allergy symptoms or to boost your immunity, Ask here.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
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