Eyeworld

EW CORNEA 98 April 2017 get more relief from a dual-action product." He tends to recommend the dual-action antihistamine mast- cell stabilizers such as olopatadine and alcaftadine. If insurance does not cover these products, there are inexpensive over-the-counter dual-action agents that are safe and effective, especially ketotifen. better, and also reduce redness and swelling. Meanwhile, artificial tears help to dilute and wash out pollens and the mediators that are released in the tears, he continued. Dr. Raizman likewise believes that there is a role for artificial tears in the management of ocular allergy. These help patients with comfort, he points out, adding that this is especially true if you chill them. "I sometimes tell patients to keep a bottle of tears in the refrigerator at home or at work and then when you put a drop in, the cold actually feels good and ends up lowering the surface temperature of the eye," Dr. Raizman said. "The tears wash away any environmental irritants and allergens that have gotten onto the ocular surface and also flushes away some mediators that are in the tear film—histamine, in particular." Dr. Udell agrees that artificial tears can help dilute the allergen but finds that these rarely suffice alone. "I can reduce the load in a sense by using the tear drops, but as long as some of that allergen gets through the tissue through the conjunctiva into the substantia propria of the conjunctiva where the mast cells reside, there will be some degranu- lation of those cells in the inflam- matory cascade, leading to some inflammatory reaction, which the patient will become symptomatic from," he said. "If a patient can use artificial tears and get complete relief, that's great, but my experi- ence is that that's not the typical patient." One option patients may turn to are over-the-counter (OTC) agents. "The prototype OTC is the vasoconstrictor antihistamine," Dr. Udell said. "They work for itch and redness, but they have short activity." What's more, they cause tachyphyaxis, so if you use them frequently, you're not going to get much of an effect and will, in fact, ultimately see more redness in the eye, he stressed. Of these, Dr. Udell tends to recommend Vasocon-A (antazoline phosphate 0.5% and naphazoline, Novartis, Basel, Swit- zerland), with the active ingredient naphazoline, which in his experi- ence tends to have the least amount of patient complaints. Such agents can work for those who have an occasional episode of an allergic response if used sparingly, he finds. Prescription products On the prescription end, Dr. Raizman finds that while mast-cell stabilizers, which keep the mast cell from degranulating, are a possibility, he rarely uses these anymore. "Some of my patients have used cromolyn (various manufacturers) and like it," Dr. Raizman said. "But most patients Season continued from page 96 " Some patients with rather severe ocular allergies may have their good days and bad days, and their eyes may look perfect the day that you see them, but they're actually quite bothered by allergy. You can't always go by the exam—the history is especially important. " —Michael B. Raizman, MD

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