There is a good chance that when patients present to you, they have likely tried and failed to treat their symptoms on their own.
- Take a thorough ocular history on anyone who has a history of systemic allergies.
- To aid in diagnosis, ask about tearing and if eye rubbing makes the symptoms better or worse. With allergies, tearing will be constant and eye rubbing will make the symptoms worse. With dry eyes, tearing will be episodic and eye rubbing will relieve the symptoms.
- Know when the allergy season hits in your area.
- Try to identify the offending allergen.
- Remind patients not to rub their eyes. Rubbing causes mast cell degranulation which perpetuates the allergic cycle.
- Most qid allergy meds can maintain a good therapeutic effect at bid following a qid loading dose. Similarly with bid meds, maintenance can be accomplished at qd dosing.
- Don't forget palliative therapies--cold compresses and artificial tears.
- In dry eye patients, nasal inhalers are often as effective in reducing allergy symptoms as oral antihistamines without drying the eye and without the systemic side effects.
- A bid topical allergy drug is always preferable in those patients wearing contact lenses.
Two studies have shown that a single dose of a mast cell stabilizing antihistamine works better at controlling itch of allergic conjunctivitis than mast cell stabilizers given for two weeks.
Other studies have shown that there is no real difference between a topical antihistamine vs. mast cell stabilizing antihistamine for controlling itch.
What studies have shown . . .
- One dose of Patanol was found to be more effective at controlling allergy symptoms when compared to Alocril taken for two weeks at bid.
- Another study found that at the one-week point, Alocril bid was just as effective as Patanol bid at controlling allergic symptoms.
- Two other studies looked at one drop of Zaditor versus two weeks Cromolyn sodium 4% and found that the multi-action drug Zaditor was better.
- Another study looked at Zaditor versus Alocril and found that Zaditor was more effective.
- A study looked at Emadine vs. Zaditor and both were equal in controlling itch.
Reference: Peake E. What today's research tells us about treating ocular allergy. Review of Optometry 2003; 65-70. |
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