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Allergies and Steroids
As many as fifty million Americans suffer from allergy and half that many may show eye signs or symptoms. With the bloom of trees, grass, and flowers in the northern climates at this time of year, many of the twenty-five million that have ocular allergies will be in optometry's chairs this month. Every journal and text that covers allergies talks about the normal paradigm of treating ocular allergies.
Usually it starts with artificial tears to remove allergens from the tear film, reduction in eye rubbing, and cool lid compresses to reduce vascular dilation and swelling. Systemic allergy control from antihistamines is often a first line of reaction from primary health care providers, and there is limited benefit to these treatments. To step up the therapeutic response, most eye care providers will recommend topical decongestant/antihistamine combination drops found over the counter. There is certainly more effect with these drugs, but the serious allergy In the last ten years, many topical antihistamine and mast cell stabilizing drugs have been very effective in management of ocular allergies. The list is long: Livostin, Emadine, Alomide, Alocril, Alomast, Optivar, Patanol, and Zaditor have come available and work quite nicely. Some doctors use non-steroidal anti- inflammatory drugs like Acular in particularly uncomfortable patients with some The advent of the "soft" steroids has made for an excellent therapeutic effect in ocular allergies. While PredForte, Vexol, and others with maximal effect are worthwhile for seasonal allergic conjunctivitis and GPC or CLPC, they aren't "site specific." Drugs like Lotemax and Alrex (one is 0.5% and the other 0.2% loteprednol) are excellent for surface treatment. And because the drug has a lipophilic property, it easily transfers into the ocular tissues. Once it creates its therapeutic effect, it is turned into an inactive form that does not further penetrate into the eye to increase intraocular pressure or cause cataracts.
Often, combination therapy is helpful, with mast cell stabilizers in conjunction with steroids leading to a nice therapeutic response. However, most doctors tend to incrementalize the treatment from a starting point of mast cell stabilizer only and adding the steroid as needed to add effect. Only when the presenting sign is "watch glass" swelling of the bulbar conjunctiva do most doctors consider using steroids. It is prudent for all eye care providers to consider the usefulness of steroids to drastically improve the allergic eye condition and consider using drugs like Alrex and Lotemax as front-line therapy for seasonal allergic conjunctivitis or GPC. Used four times a day for a week, they can drastically improve the condition and be followed with maintenance treatments like Patanol or Zaditor at twice daily dosing for the remainder of the condition's duration.
If you have ever suffered from ocular allergy symptoms, you know the misery. Our patients deserve an opportunity at immediate effect from our treatments, so consider topical steroids next time you see eye allergies.
2717 Emerson Avenue South, Minneapolis, MN 55408 For an in-depth look at an online piece that includes a section on steroids in ocular inflammation and allergy, visit this Pacific University page: For a nice case report presentation about ocular allergies, visit this Indiana Disclosure: EyeCodeRight and the author have no financial interest in any of the 2717 Emerson Avenue South, Minneapolis, MN 55408


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