Q: I have a couple times a year when my eyes feel even itchier than usual, and my husband notices my eyes are red. Should I take something in a pill or an eyedrop?
A: While summer is peak allergy season for about 35 percent of the population, a higher number of people have some degree of year round, or “perennial” allergy. You ask a great question, because it turns out most people are doing the wrong thing for eye allergies.
Very commonly, people take an over the counter allergy pill when the symptoms are mostly in the eye. As you might guess, the best treatments are eye drop medications, applied directly to the eye. Oral medications can have a mildly helpful effect with itchy eyes, but unfortunately they also cause severe drying of the eye surfaces. While several oral medications like Claritin and Allegra are non-drowsy, they are not non-drying. Your eyes need the proper layers of protective moisture to prevent infections and other more severe conditions.
We treat “seasonal” allergy differently than perennial allergy. For the sudden, severe episode of red, itchy, watery eyes we prescribe very potent topical ophthalmic antihistamines and sometimes specialized ocular steroids. These drugs act quickly, reducing symptoms within three minutes, and reducing signs ( swelling, redness, watering ) within a half hour. Some of these medications are so powerful that patient usage is limited to several days or a couple weeks at most.
The year-round allergy is more likely due to pet dander and/or dust mites. Cat dander is very inflammatory to many people, and may require a little stronger treatment, along with wiping your cat each day with a moist washcloth (good luck with that). Dust mites are everywhere, but accumulate in our pillows especially. Lifestyle changes may be needed to control this, but we would prescribe a safer, long term eye drop that you would instill in your lower eye lid once or twice a day.
Lastly, there a couple older eye drop products sold over the counter that offer mild help, but for most patients, seeing your eye doctor for an accurate diagnosis should be step one. After your initial episode is under control, we try to move patients to a milder and less expensive treatment for the long term. This may include an eye wash and cold compresses, along with some lifestyle alterations. See you eye doctor before this summer’s flare up, if this seems to happen every year, and have the medications on hand in the refrigerator ahead of time. Your eye doctor is the best choice to sort out contagious pink eye from allergic issues or other eyelid problems.
DR. THOMAS STOUT, OD, FAAO is an eye physician in private practice at Morgantown Eye Associates. Info: MorgantownEye.com.