Boy did these allergies start early this year!
If you have dry eye, managing your allergies can be tricky and confusing to say the least! You don’t want to try to treat one problem while making another one worse, and it can also be hard to differentiate dry eye and ocular allergies from one another. Let me say I speak from not only professional but also personal experience – I have chronic dry eye as well as a lifelong history of allergies and a lengthy sinusitis history which I passed down to my two children. So I am right there with all of you!
There are 2 main types of dry eye – and both of them can be exacerbated by allergies.
There is the type of dry eye where your lacrimal gland does not produce enough of the middle watery layer of your tear film. This layer is very sensitive to the dehydrating side effects of medications. Anything that dehydrates your body will dehydrate your eyes. So think about those antihistamines you take during allergy season – I have seen patients greatly improve their dry eye signs and symptoms simply by carefully working through their oral allergy medications with them and adjusting appropriately.
The other type of dry eye involves the top oil layer of your tear film which normally prevents your tears from evaporating. This oil is secreted from meibomian glands in your eyelid. 86% of dry eye involves these glands being clogged and causing an evaporative dry eye. Most of us are walking around with some level of clogging in these glands. Over my career I have noticed that the Spring, particularly April, is chalazion or “stye” month. A chalazion occurs when one of these glands becomes especially clogged and you get an inflamed lump on your eyelid. We know that inflammation is a major contributing factor to these glands becoming clogged – so it is no surprise to me that during allergy season that little extra bit of inflammation often pushes people’s glands over the edge in the form of a stye. In fact, last Spring when our office was closed to all but emergency care and telemedicine during the worst of the coronavirus pandemic, my main concern was that it was in fact stye season. If left untreated, these can occasionally spread to an infection that involves the entire eyelid which requires treatment with oral antibiotics. If this remains untreated, it can even spread to the tissues behind the eye, which is a true emergency due to proximity to the brain and requires hospitalization with IV antibiotics. The last thing patients and the hospital systems needed last April was styes in the emergency room! This was why we utilized things like emergency office visits and telemedicine so rigorously to keep in touch with our patients.
Bottom line is – if you have a stye, do not hesitate to come in for an evaluation and let us help you get rid of it ASAP!
So how should we treat ocular allergies without making dry eye worse?
Well first of all we should recognize the subtle yet specific signs of ocular allergies that can often differentiate it from dry eye. Itching is the classic hallmark of allergies, as well as stringy white ropy discharge. It can sometimes involve swelling of the eyelids. Allergies tend to get worse overnight as we sleep, and if you are a side sleeper the resultant inflammation will drain to whatever side you are sleeping on. This is why occasionally my allergy patients will wake up with a red swollen eye that is worse on the side they are sleeping on. Signs and symptoms that cross over with dry eye are watering, redness, and a foreign body sensation. These usually have a more chronic, long term nature in dry eye and take on a more acute, short term, aggressive pattern in allergies.
If your allergy symptoms are mainly ocular in nature, meaning you don’t have a whole lot of other issues like asthma and sinusitis, I often recommend that my patients try to skip the oral medications altogether and simply start with an allergy eye drop. Oral antihistamines just do not penetrate the ocular surface significantly, and as I mentioned earlier will typically exacerbate dry eye. I am so excited that for the first time we have a preservative free alternative – Alaway is an over the counter allergy eye drop that now comes in a preservative free form. You have to make sure you are buying the vials and not the bottle. Preservatives (which are typically found in eye drops that come in a bottle) have been proven in studies to have a significant negative impact on the delicate tissues of the cornea, conjunctiva, and meibomian glands, so it is always best to avoid them when possible.
Nasal sprays can also be a useful item in your toolbox for fighting allergy symptoms. The jury is still out on whether these nasal sprays contribute to or alleviate dry eye symptoms. Additionally, a potential side effect of steroidal nasal sprays is an increase in IOP (intraocular pressure). Increased IOP is a risk factor for glaucoma. Because of this, it is best to consult with your eyecare professional about the use of these.
Taking a drug free minimalist approach, some patients simply prefer to use preservative free artificial tears to rinse the pollen out of their eyes as well as cool compresses to calm down the swelling and inflammation associated with ocular allergies. Saline sinus rinses can also provide significant relief. It is important to remember that you have 4 sets of sinuses – 1 above your eyes, 1 below your eyes, and 2 behind your eyes. So the majority of the time, pain and pressure behind your eyes can be blamed on sinusitis, which of course kicks up during allergy season. Sinus rinses can help alleviates these symptoms. You should obviously still take symptoms of eye pain seriously and let our doctors at Siepser Eyecare rule out other more serious causes of eye pain such as intermittent IOP spikes.
And if you really feel like you need guidance and just have no idea if you are dealing with dry eye or allergies, please always feel free to come in for an evaluation. Our doctors at Siepser Eyecare provide comprehensive eye exams and we are committed to manage your ocular health concerns. As I mentioned, I am a dry eye and allergy sufferer, so I can commiserate! After years of treating dry eye in our main clinic, I am so excited about the upcoming opening of the Dry Eye Center in the King of Prussia (Wayne) office at Siepser Eyecare. I cannot wait to start evaluating and treating patients in our new specially designed dedicated space for our Dry Eye Center of Excellence, I hope to see you in the near future!