Eyeworld

EW CORNEA 60 March 2016 by Maxine Lipner EyeWorld Senior Contributing Writer Luise explained. Still, this may be too detailed for many practitioners. "Once you start getting involved in identifying specific allergens, you may want to consider a referral to an allergy colleague," he said. Initial measures For ocular allergy patients, some initial non-pharmacologic mea- sures that may make a difference include the use of cold compress- es, ice packs, and the use of a cold mist humidifier, Dr. de Luise said. Artificial tears may be the next line of defense. Dr. de Luise finds that chilled, non-preserved artificial tears may be all that some patients need. "The artificial tears dilute the aller- gens in the tear film and inflamma- tory mediators such as eosinophilic chemotactic factors that may be present on the ocular surface," he said, adding that nighttime gels may also be beneficial as they provide a barrier to allergens. For many patients, the over-the- counter shelves are the first stop. Mark Abelson, MD, clinical profes- sor of ophthalmology, Harvard Med- ical School, and emeritus surgeon, Massachusetts Eye and Ear, Boston, said that these come in 2 catego- ries. Vasoconstrictor/antihistaminic agents include Naphcon-A (Alcon, A llergy is a problem that affects about 60 million Americans, with about half of those people deal- ing with ocular allergy, according to Vincent de Luise, MD, assistant clinical professor of oph- thalmology, Yale University School of Medicine, New Haven, Conn. For many, the culprit is seasonal allergic conjunctivitis, and currently, there are a number of treatment strategies to help sufferers. First, physicians must identify ocular allergy sufferers. "The classic sign of allergy is a red eye and a papillary conjunctival response," Dr. de Luise said. "Itching is the hallmark symptom of allergy." In fact, he stressed, practitioners cannot make the diagnosis of ocular allergy without patients either vol- unteering that they have itch or the doctor eliciting this from them. One new way that some practi- tioners are helping patients identify the source of their allergy is with an in-office Doctor's Allergy Formula skin test (Bausch + Lomb, Bridgewa- ter, N.J.). With this, a panel of 10 al- lergens are pressed into the patient's skin, and about 10–15 minutes later, the practitioner may be able to give the patient more information on what is causing the allergy, Dr. de Ocular allergies: Itching for a pharmacologic response When eyes are subjected to an ocular allergy challenge, physicians can see on a cellular level what is going on with the aid of confocal microscopy. Pharmaceutical focus Fort Worth, Texas), Opcon-A (Bausch + Lomb), Vasocon-A (Novartis, Basel, Switzerland), and Visine-A (Johnson & Johnson, New Brunswick, N.J.). The ketotifen compounds include Zaditor (Novartis) and Alaway (Bausch + Lomb). While Dr. Abelson thinks that the vasoconstrictor/antihistaminic agents work to take the edge off, he finds that they don't offer a huge amount of itching relief. "The keto- tifen compounds are more robust," he said. Ira Udell, MD, chairman, Department of Ophthalmology, Long Island Jewish Medical Center, North Shore University Hospital, and professor and chairman, Depart- ment of Ophthalmology, Hofstra Northwell School of Medicine, Hempstead, N.Y., finds that over- the-counter agents like Naphcon-A, Opcon-A, and Visine-A are useful short-term solutions for itching and redness. "But the negative is if you continue to use them and you're using them every 4 hours, there may be a certain amount of rebound ef- fect," he said. "Patients may be sus- ceptible to having more redness and irritation in the eye." All of these agents have benzalkonium chloride (BAK) preservatives, he noted, which can become an issue. Combination agents Next up for many patients are the combination antihistamine/ mast cell stabilizers. These include agents such as Patanol (olopatadine hydrochloride ophthalmic solution 0.1%, Alcon), Pataday (olopatadine hydrochloride ophthalmic solution 0.2%, Alcon), Pazeo (olopatadine hydrochloride ophthalmic solution 0.7%, Alcon), and Bepreve (bepotas- tine besilate ophthalmic solution 1.5%, Bausch + Lomb), Dr. de Luise noted. He said these work to block the histamine that has already been released and can make patients feel better quickly. "They will also stabilize the cell membrane of the mast cell and thereby contain some of the inflammatory mediators that are about to be released," Dr. de Luise said, adding that they'll stop the degranulation process so that the mast cell will not release even more antihistamines or eosinophilic chemotactic factor into the tear film and wreak more havoc. Dr. Udell describes the origi- nal Patanol as a twice-a-day drug. "When they came out with Pataday, it had a label of once per day," Dr. Udell said. The newest version of olopatadine, Pazeo, is a 0.7% con- centration and is also once a day. Dr.

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