Seasonal Allergic Conjunctivitis (SAC) can be frustrating, painful and disruptive. While we can’t change the seasons, we can help patients to minimise the impact that allergic eye diseases have on their day-to-day lives.
Australia and New Zealand have the highest prevalence of allergic disorders in the developed world.1 It stands to reason then that over the coming months of spring and early summer, many of your patients will complain of itchy, red, watery or stinging eyes caused by airborne allergens from trees and plants.
Allergic conjunctivitis affects the conjunctiva of the eye – the thin, translucent lining of the eyeball, as well as the under-surface of the eyelid.
Symptoms
According to a report in Medicine Today, more than 75 per cent of Australians who suffer from allergic eye diseases have reported an adverse effect of this condition on their quality of life, “as measured by indicators such as lack of a good night’s sleep, reduced productivity and intrusive symptoms, amongst others.”3
Allergic conjunctivitis affects the conjunctiva of the eye – the thin, translucent lining of the eyeball, as well as the under-surface of the eyelid
Those symptoms are itching, redness and lid swelling, usually in both eyes. Additionally patients may complain of burning and watery discharge. In the acute state, a white exudate may form that becomes stringy in the chronic form. Conjunctival chemosis may be evident in more severe cases.2
Other Atopic Diseases
Those who suffer from allergic conjunctivitis usually have a history of other atopic diseases, such as eczema or asthma. According to one report, “97 per cent of children with allergic rhinitis (hayfever) also have allergic eye symptoms. In children with asthma 56 per cent experience allergic eye symptoms, and 33 per cent of children with eczema have allergic eye symptoms. In one large study of asthma and allergies, in nearly 500,000 children across several different countries, a slight increase in the rate of allergic conjunctivitis was noted.”2
Seasonal Allergies Most Common
Of all the forms of allergic conjunctivitis, Seasonal Allergic Conjunctivitis (SAC), is the most common. This condition, which is related to fluctuating levels of air borne allergens such as grass and tree pollens, represents half of all cases of allergic conjunctivitis. Other cases include Perennial Allergic Conjunctivitis, Vernal Keratoconjunctivitis, Atopic Keratoconjunctivitis, Giant Papillary Conjunctivitis, Viral Conjunctivitis, HSV Conjunctivitis, BC – Acute Form, and Chlamydia Conjunctivitis.3
Minimising the Risk
While there is no way to completely protect your patients from seasonal allergic eye disease, there are some strategies to minimise contact with air borne allergens. Of course the first step customers should take is to undertake allergy testing to identify the specific allergens causing the problems. This may help your customers avoid the particular environments that put them at risk.
Additionally, there may be opportunities to undertake immunotherapy in an effort to lessen the immune reaction experienced. Immunotherapy involves giving patients small doses of the allergen that they are sensitive to, in an effort to help them build tolerance.
In most cases though, allergens will be difficult to avoid, especially on hot, dry, windy days, so it is important for sufferers to take practical, proactive precautions. One of these is to create a barrier against airborne allergens by wearing sunglasses when outdoors, particularly on windy days. Another is to remain inside as much as possible and use air conditioning.
Customers who wear contact lenses should be alerted to the need to take extra care during allergy season because allergens can adhere to the inside of the lens surface. Experts say that should any discomfort be experienced while wearing contact lenses during allergy seasons, people should remove them for a period and wear spectacles. Glasses are recommended over contact lenses when gardening or mowing the lawn. Additionally, they recommend avoiding wearing contact lenses outside when the conditions are hot, dry or dusty and when pollen counts are particularly high.
Maximising Comfort
Those who feel the irritating effects of seasonal allergic conjunctivitis are able to treat the symptoms with both nonpharmacological and pharmacological intervention.
Recommended nonpharmacological treatments include cool compresses to alleviate itches, lubricants to dilute allergens and inflammatory mediators to lessen trauma. Reportedly, refrigerating eye drops can also help to relieve symptoms. Eye rubbing should be avoided as rubbing can exacerbate inflammation.1
Experts say that patients who require pharmacological therapies to treat mild allergic symptoms can be treated with a combination of short-term topical astringent and antihistamine therapies. Oral antihistamines can help relieve many of the patient’s symptoms and more specific therapies including histamine blocking drops and topical mast cell stabilisers can also be beneficial. As mast cell stabilisers can take three to seven days to take effect, they should be considered as a preventative treatment and used through much of the year.
Topical non-steroidal anti-inflammatory agents (NSAIDs) may be considered in some cases of allergic conjunctivitis, as they reduce itchiness and redness. However, experts say that significant side effects can occur and so treatment should be monitored.
While patients, in conjunction with their optometrist and general practitioner, can adequately manage most allergic eye diseases, vision threatening complications can arise. In this case, patients should be referred to an ophthalmologist.
References
1. www.allergy.org.au/content/view/325/76/
2. Allergic rhinoconjunctivitis and differential diagnosis of the red eye, David Garnet, FAAO, FAAP. Allergy and Asthma Proceedings 29:565-574, 2008; doi: 10.2500/aap.2008.29.3170
3. Classifying and managing allergic conjunctivitis, Greg Moloney MB BS and Peter J. McCluskey MD, FRANZCO, FRACS, published in Medicine Today, November 2007, Volume 8, Number 11
4. www.virtualmedicalcentre.com/diseases.asp?did=933#Statistics
