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Treating allergic conjunctivitis requires multifactorial approach, speaker says
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NEW YORK — Doctors must consider all possible factors when attempting to treat a patient with allergic conjunctivitis because not all allergies are the same, a speaker said here at Vision Expo East.
"You can’t take a one-size-fits-all approach to treating allergic conjunctivitis,” Eric Schmidt, OD, said during a continuing education course on ocular allergies. “You have to tailor the treatment to the degree of severity of the signs and the severity of the symptoms.”
“If a patient comes into my office for itchy, teary eyes, the first thing I think of is a topical antihistamine — that’s your go-to,” Schmidt said.
“But that can’t possibly cure everybody,” he said. “Patients will have different responses to the antihistamine; there are different allergens out there that respond differently; a patient’s ethnicity plays a role; their age; and the side effects of the drops. You have to take everything into account, or you won’t get the best outcome.”
According to Schmidt, treatment options include advising the patient to avoid the allergen, in cases of cat or dog allergies, for instance; artificial tears; sterile irrigation; topical decongestants; topical and systemic antihistamines; mast-cell stabilizers; dual-acting antihistamines and mast-cell stabilizers; nonsteroidal anti-inflammatory drugs; and corticosteroids.
Dual-acting antihistamines and mast-cell stabilizers are the most effective at treating allergic conjunctivitis, he said.
“They competitively bind to the H1 receptors in a higher concentration than the histamines so the histamines can’t get at the receptors, which prevents the histamine-H1 receptor bond that causes itching and tearing,” he said. “And then they also coat the mast cells so they don’t degranulate and produce more histamines that would overwhelm the drop.”