Clinical pearls for Autumn’s allergies

Autumn's tell-tale signs are all around—a crispness in the morning breeze, trees glimmering with hints of yellow, nightfall arriving earlier and airborne pollen counts soaring.

Itchy, teary eyes and drippy noses are often associated with the springtime bloom, but fall spores can be equally as harsh on allergy sufferers. One pollen perpetrator in particular, ragweed, often reaches peak levels in mid-September, causing allergic rhinitis in as many as 23 million Americans. But there's also the ubiquitous mold and dust mites that get stirred up while raking leaves or opening stagnant furnace vents when fall turns cold.

In short, many Americans are about to experience a resurgence of their seasonal allergies, and eye discomfort ranks high among their symptoms.

"Allergic eye disease is one of the most common ocular conditions that we see in practice as it affects patients of all ages, including children" says Jennifer Harthan, O.D., chief of the Cornea Center for Clinical Excellence and associate professor at Illinois College of Optometry.

Below, Dr. Harthan shares several clinical pearls for doctors of optometry helping patients with seasonal allergies.

1. Do the legwork. When seeing patients with allergic conjunctivitis, it is important to not only ask about history of allergic rhinitis, but also about a history of other atopic diseases, such as asthma and eczema, Dr. Harthan says. Often, patients will present with itching, redness, tearing, mucus discharge, lid welling and rhinitis, so work-up should include an evaluation of lids to look for conjunctival inflammation and a papillary response. The practitioner may also see chemosis, lid edema and mucus discharge, she says.
2. Tailored treatment. Before settling on a management plan, discern whether the patient has allergic conjunctivitis alone or whether they have systemic involvement. In the case of the former, suggest supportive therapy that includes avoidance of allergens, cool compress and artificial tears, Dr. Harthan says. Topical management usually involves a combination of antihistamines, mast cell stabilizers, combination drops, NSAIDs, steroids and topical cyclosporine, depending on severity, she says. Consider nasal antihistamines/mast cell stabilizers or nasal steroids for patients with allergic conjunctivitis and rhinitis, but practitioners must watch intraocular pressure closely, Dr. Harthan notes.
3. Contact lens considerations. Those patients who wear contact lenses and suffer from allergies may benefit from a re-fit into daily disposable lenses to improve ocular comfort. While patients with irregular corneas and more complex ocular surface disease in specialty contact lenses may do well with hydrogen peroxide solutions or even stronger cleaners, Dr. Harthan says.
4. Collaborate for the patient's benefit. Should a patient present with systemic allergies, it's important to co-managed with the patient's primary care physician and/or allergist, Dr. Harthan notes. So, too, patients presenting with signs and symptoms of allergic conjunctivitis should be billed medically and followed appropriately until improvement is noted.

"Allergic conjunctivitis can affect a patient's quality of life, but by managing their condition appropriately, you create a patient for life and it can be a huge practice builder," Dr. Harthan says.

Read more helping patients manage allergies, and access the AOA's evidence-based clinical guideline, Comprehensive Adult Eye and Vision Examination.