Consider ocular allergy first when treating eye conditions

MADRID, Spain — Ocular allergies are the most common eye condition, and should be an integral part of patient evaluation, said Mark B. Abelson, MD, here during the Congress of the European Society of Ophthalmology.

Of the general population, 20% has allergies and 90% of ocular allergies are seasonal in origin, and 60% include rhinitis, said Dr. Abelson. Traditional treatments target the eye and the nasal passages; newer medications focus on mast-cell production.

“In the allergic state, [mast cells] are found in more superficial layers,” he said. “Mast cells come from the bone marrow … [and] come under control of the microenvironment.”

There are two classes of mast cells: tryptase and chymase. The types of mast cells respond to drugs differently, he said.

Most ocular conditions initially present as a red eye, however, this clinical sign can be a variety of conditions, said Robert Gross, MD. Common conditions are dry eye disease, atopic keratoconjunctivitis, vernal keratoconjunctivitis, giant papillary conjunctivitis, meibomianitis and blepharitis, he said.

Dr. Gross advised physicians to consider the patient’s ocular symptoms and history to determine the primary source of the allergy. Whereas itching typically indicates an allergy, pattern redness may indicate hyperemia. Sticky eyelids may indicate bacterial conjunctivitis, Dr. Abelson added.

Topical therapy is preferred for topical conditions, Dr. Gross said. He recommended a nonsedating, nondrying anti-histamine. Preservative-free artificial tears are commonly recommended, he said.

Olopatadine 0.1% (Patanol, Alcon) is the most common medication prescribed for ocular allergy in the United States, said Peter D’Arienzo, MD. Last year, olopatadine was approved in Europe under the brand name Opatanol.

Dr. D'Arienzo discussed numerous studies comparing olopatadine to various ocular medications. In each study, olopatadine eye drops succeeded in being the most effective and comfortable drug.