Allergic conjunctivitis: treatment
Dry eye syndrome is a condition without a cure, but the main self-help measure is to assess what may be aggravating the problem
Posted: 29 April 2016
If you’ve missed yesterday’s episode of this week’s feature on allergic conjunctivitis, click here.
Writer: Asha Fowells
Allergic conjunctivitis and dry eye caused by hay fever can cause major discomfort for patients during the summer months.
Dry eye syndrome is a condition without a cure, and those who suffer one episode tend to be more prone in the future. The main self-help measure is to assess what may be aggravating the problem – for example, wearing contact lenses, smoking, using a computer for long periods, or taking medication that can exacerbate dry eyes such as vasoconstrictor eye drops, hormone replacement therapy, diuretics, antihistamines, tricyclic antidepressants and selective serotonin reuptake inhibitors – and then try and mitigate that factor.
Correcting any environmental issues can also be helpful, for example, reducing central heating temperature or using a humidifier to slow down evaporation of tears, ensuring fluid intake is ample to aid hydration, and avoiding eye make up which may block the tear ducts and cause irritation of the skin around the eyes. Assuming any other underlying causes have been addressed, mild cases may respond sufficiently to such measures so as to avoid any other treatment. Omega-3 fatty acids, which are found in oily fish, are sometimes heralded as a solution, but there is mixed evidence as to whether they reduce tear evaporation and inflammation.
Patients experiencing more severe symptoms may need to add an ocular lubricant ointment to their treatment. Paraffin products are cheap and effective, but can blur vision and are not suitable for use with contact lenses, so should only be used at night. Acetylcysteine drops may be helpful for individuals who have visible mucus strands on their eye(s) because of the drug’s mucolytic properties, but these are likely to sting upon application.
If inflammation is thought to be a component of a patient’s dry eye syndrome, an anti-inflammatory agent may be prescribed, such as a topical corticosteroid, oral tetracycline or topical ciclosporin. These should only be initiated by an ophthalmologist and require close monitoring. Very occasionally, autologous serum eye drops – made using components of the patient’s own blood – may be used.
Surgery is reserved for those with severe symptoms that do not respond to other treatments. The most common procedure is punctal occlusion, which involves sealing the tear ducts so tears do not drain from the eyes and therefore they remain moist. Very rarely, salivary glands may be removed from the lower lip and placed under the skin around the eyes to act as a tear replacement.