This article is more than 5 years old. Information may no longer be current.
Allergy, dry eye have both shared and distinct mechanisms
When allergy and dry eye syndrome coexist, it is important to address the dryness to provide optimal allergy treatment, a physician says.
Click Here to Manage Email Alerts
DANA POINT, Calif. – When dry eye syndrome and ocular allergy coexist, it is best to treat the dry eye to help resolve the allergic reaction, according to Reza Dana, MD, MPH, MSc.
| Reza Dana |
Ocular allergy and dry eye syndrome have both shared and distinct mechanisms, Dr. Dana said in a presentation on the two ocular surface conditions here at the Ocular Drug and Surgical Therapy Update meeting.
“When you have dryness symptoms, they often can compound the symptoms of allergy and contribute to the pathogenic mechanisms operational in allergy,” Dr. Dana said in a telephone interview after the meeting. “By treating dryness, you minimize the preponderance or chances of the allergen landing on and adhering to the eye surface. If the surface is wet, the allergen will get flushed away through the canalicular system.”
Coexisting conditions
When dry eye and allergy coexist, treating the dry eye syndrome can be crucial to resolving the allergy problem, Dr. Dana said.
“Dry eye and allergy often coexist,” he said. “This is a fact that is frequently overlooked by clinicians who frequently see patients with a red eye.”
Inflammation plays a critical role in the pathogenesis of ocular surface disease for both conditions, Dr. Dana said.
“Physicians may often make a misdiagnosis of infectious conjunctivitis without appreciating that they can co-exist,” he said.
Mainstay treatments
As with the disease mechanisms, the treatments for dry eye and allergy have some overlaps and some differences, Dr. Dana said. Both conditions can be helped by tear supplementation, but other treatments for ocular allergy and dry eye differ.
The mainstay treatments for allergy are topical antihistamines and mast-cell stabilizers, and the mainstays for dry eye are tear supplementation and anti-inflammatory treatment, he said.
“For a mild dry eye, the use of lubricants is frequently adequate, but in moderate to severe dry eye the best therapeutic aid is when anti-inflammatories are employed,” Dr. Dana said.
Restasis (cyclosporine, Allergan) is most effective when it is used in conjunction with frequent artificial tears and a short course of mile topical steroids just before Restasis is initiated, Dr. Dana said. He emphasized that there are many side effects of topical steroids, and he suggested that clinicians should not provide refills for topical steroids to their patients, who may be tempted to abuse these products given how effective they can be in providing symptomatic relief.
Future treatments
It is estimated that up to 30 million Americans have dry eye, Dr. Dana said.
“There are at least nearly 10 million with clinically significant disease as per our published studies,” he said.
“There is a lot of interest in dry eye right now because it is a billion dollar market,” Dr. Dana continued. “There is a lot of interest in developing new therapeutics.”
Restasis, which was approved in 2003, is currently the only prescription therapeutic drug approved by the Food and Drug Administration for treatment of dry eye, Dr. Dana said. But a number of studies currently under way are likely to produce new dry eye treatments in the future, he said.
“There is a whole host of novel anti-inflammatory compounds that are being tested right now in the clinic. Another area of intensive research that shows great promise is development of novel secretagogues that promote aqueous and/or mucin secretion,” he said.
One approach that is being investigated is hormone therapies to treat dry eye, Dr. Dana said. For example, he said, a topical testosterone compound for treatment of dry eye being developed by Allergan is currently in phase 3 trials.
As for new allergy treatments, Dr. Dana said research has focused on optimizing current mast cell stabilizers.
“The other area for treating allergy is making the intervention more precise on the molecular level,” Dr. Dana said.
Lifestyle changes
The effects of both allergy and dry eye can in many cases be ameliorated by changes in the patient’s environment, Dr. Dana noted.
“Many physicians tend to just think about the drugs, but they may be overlooking simple behavioral changes that patients can adopt to help them with their conditions,” he said. “Allergy, by definition is a response to allergens in the environment, such as dust, cat dander and pollen. There are a variety of things one can do generally aimed at minimizing exposure to materials one is allergic to.”
Some of the actions patients can take to minimize allergens may include removing old carpets or sofas, or simply understanding that they may be allergic to their pets, Dr. Dana said.
For dry eye, Dr. Dana said he suggests to patients that they take simple steps, such as making sure the vents in their car are not blowing in their face, or changing ergonomic features in their office.
“By simply placing their computer screen lower, they can reduce the upward gaze,” he said. “Some people use goggles, humidifiers or make sure the air conditioners are not blowing in their face. Things like that are very helpful.”
A note from the editors
The Ocular Drug and Surgical Therapy Update, a continuing medical education activity sponsored by SLACK Incorporated, the publisher of Ocular Surgery News, was supported by an unrestricted grant from Allergan.
For Your Information:
- Reza Dana, MD, MPH, MSc, can be reached at the cornea service of Massachusetts Eye and Ear Infirmary, Harvard Medical School, Department of Ophthalmology, 243 Charles St., Boston, MA 02114; 617-912-7401; fax: 617-912-0117; e-mail: dana@vision.eri.harvard.edu.
- Allergan, maker of Restasis, can be reached at P.O. Box 19534, Irvine, CA 92623; 714-246-4500; fax: 714-246-4971; Web site: www.allergan.com.
- Daniele Cruz is an OSN Staff Writer who covers all aspects of ophthalmology.