EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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E W NEWS & OPINION 14 Where we are in 2014 S pring is in the air and that has many ocular allergy sufferers heading for the proverbial hills. From over-the-counter (OTC) medication to the latest prescription drops, we're honing in on what p atients today are using to forestall their ocular allergy symptoms. EyeWorld asked leading practitioners to give their thoughts on where these treatments currently stand. Off the shelf Henry D. Perry, MD, professor, North Shore University Jewish Med- i cal Center, Rockville Centre, N.Y., sees the role of OTC medications as weeding out patients with signifi- cant problems from those with very mild transient issues. "I think the majority of patients who have mild hay fever-type conjunctivitis can be aided by the various OTC combina- tions that exist," Dr. Perry said. He f inds that vigorous use of non-pre- served artificial tears can sometimes be enough to ameliorate the signs and symptoms. "They can help to wash away some of the allergens that occur," he said, adding, "They can also provide a mild coating of the corneal surface." He finds those he ends up seeing in the office have f ailed conservative measures. Likewise, Randy J. Epstein MD, professor of ophthalmology, Rush University Medical Center Chicago, and in private practice, Chicago Cornea Consultants, sees a role for these. An allergy sufferer himself, OTC medication is a part of his regimen. "Five minutes ago I p ut Naphcon-A [naphazoline hydrochloride and pheniramine maleate, Alcon, Fort Worth, Texas] in my eyes," he said. "That product is my first choice in prescribing be- cause it's cheap, it's widely available, and it also contains a vasoconstric- tor that makes the redness go away immediately, which patients really appreciate." He pointed out that many previ- ous prescription-only medications like Zaditor (ketotifen fumarate ophthalmic solution, Novartis, Basel, Switzerland) eventually became over-the-counter drugs. However, Michael S. Blaiss, MD, clinical professor of pediatrics and medicine, University of Ten- nessee Health Science, Memphis, has concerns about many over-the- counter allergy remedies. He pointed out that OTC oral antihistamines such as Benadryl (diphenhydramine, Pfizer, New York), Zyrtec (cetirizine, McNeil Consumer Healthcare, Fort Washington, Pa.), or Claritin (loratadine, Merck, Whitehouse Station, N.J.) are in many cases not that beneficial as far as helping or controlling moderate-to-severe allergic conjunctivitis. "In fact, first generation and even some of the second generations may have some anticholinergic activity, which leads to a worsening of eye problems because they can dry out the eye," Dr. Blaiss said, adding that this may worsen the patient's eye condition. He urges care even with topical OTC medications, such as the vaso- constrictors, which he noted are not going to treat the underlying prob- lem. Chronic use to treat redness, he observed, can cause a rebound effect February 2014 by Maxine Lipner EyeWorld Senior Contributing Writer Ocular allergy treatments Papillary conjunctivitis under the upper eyelid is typically seen on slit lamp examination in patients with allergic conjunctivitis. Source (all): Randy J. Epstein, MD Chemosis or fluid accumulation under the conjunctiva in an ocular allergy patient continued on page 16 Pharmaceutical focus 13-25 News_EW February 2014-DL2-ALT-OIS-ad_Layout 1 1/30/14 10:07 AM Page 14