Ocular Allergies

Ocular allergies are specific immunologic changes that result in inflammation on the conjunctival surface. This is a response to an increased level of Mast cells in the surface tissue and will result in a mild allergic reaction. When immunoglobulin E is introduced and interacts with a mixture of mast cells, lymphocytes and eosinophils, the allergic response is more severe and corneal involvement is much more likely.

There are several types of allergic reactions that affect the eyes. Seasonal allergic conjunctivitis is one of the most common types and is a typical reaction to Ragweed pollen and other environmental allergens. Perennial allergic conjunctivitis is a variant of the seasonal type, but reoccurs yearly in response to exposure to a certain allergen. Vernal conjunctivitis is uncommon and is a chronic type of the seasonal allergic conjunctivitis. This type more often occurs in children. Giant Papillary Conjunctivitis is most often associated with contact lens wear and is a reaction to exposure to surface debris. It results in follicles and papilla (bumps) on the inside surface of the lids. Finally, contact dermatitis is an acute response to exposure to an allergen. It results from touching an allergen and then rubbing the face or eye lids. This causes exposure and red, itchy, scaly skin is the result. There may be ocular involvement if the eye is exposed as well as the skin.

Treatment options vary depending on which allergy the patient suffers from. Surface allergies like contact dermatitis are best treated initially by cool compresses. Oral antihistamines interfere with systemic involvement, but are not the best choice for the surface disease of the eyes. Vasoconstrictors are available over the counter, but don’t work that well for moderate to severe reactions.

Mast cell stabilizers have been around for some time and are effective in reducing some of the symptoms, but still leave the patient uncomfortable. The newest treatment modality is the combination multi-action surface medicine like Patanol and Pataday. This medication is comprised of mast cell stabilizers and antihistamines. They attack the entire source of the disease process. Relief is quick and with Pataday which is a single does per 24 hours, long lasting and easy to use. The only stronger topical medication is steroids. They will resolve the symptoms and red eyes and are used in severe allergic reactions. The only problem is that they can NOT be used for prolonged treatment due to the severe side affects. When a bad allergy is encountered, steroids can be employed to start the treatment and then change to medications like Patanol/Pataday for long term therapy.