Kate Johnson

November 11, 2014

ATLANTA — Patients with allergic eye symptoms can also have concomitant dry eye disease, and the combination of the two conditions often means that symptoms are more numerous and more severe, say investigators.

"The treatment of patients suffering from both allergic conjunctivitis and dry eye disease includes discontinuation of many oral antihistamines, as they have anticholinergic properties that exacerbate dryness," senior investigator Leonard Bielory, MD, from Rutgers University in Springfield, New Jersey, told Medscape Medical News.

In their study, Dr Bielory and colleagues compared the prevalence and severity of dry eye disease in a national cohort of 9216 ophthalmology patients (mean age, 55 years) and 68 allergy patients (mean age, 49 years). Results were presented here at the American College of Allergy, Asthma & Immunology 2014.

Patients completed a questionnaire that asked about symptoms of dry eye disease, including fluctuating vision, lens discomfort, light sensitivity, watery eyes, tired eyes, redness, burning, itching, and grit.

They were also tested for tear hyperosmolarity, which was defined as osmolarity above 285 mOsm/L; levels above 308 mOsm/L were considered to be consistent with dry eye disease.

Dry eye disease was more prevalent in the ophthalmology patients than in the allergy patients (51.6% vs 37.5%). However, allergy patients with concomitant dry eyes were more likely to have more severe disease — defined as having more than 4 symptoms — than ophthalmology patients (42.6% vs 15.8%).

In addition, mean hyperosmolarity was more severe in allergy patients with dry eye disease than in ophthalmology patients with dry eye disease (337 vs 323 mOsm/L; P < .0001).

Differentiating Between Conditions

Although this study shows that allergic eye symptoms and dry eye disease often overlap, dry eye is often not investigated or treated in the allergy setting, said study investigator Brett Bielory, MD, from the New York Medical College in Valhalla. "Objective testing can really help differentiate between the two etiologies."

In addition to tear osmolarity, other objective tests for dry eye disease are tear production measured with Schirmer's strips and tear breakup time.

"Consider asking about additional symptoms aside from redness and burning, such as a gritty or sandy sensation or watery tired eyes," he said.

When the two conditions do overlap, switching therapies can often make a big difference, Dr Leonard Bielory pointed out.

 
Consider asking about additional symptoms aside from redness and burning, such as a gritty or sandy sensation or watery tired eyes.
 

"If they also demonstrate nasal allergies, the use of intranasal steroids as treatment for nasal allergic inflammation also decreases the inflammation on the ocular surface," he said. "Immunotherapy remains a cornerstone of treatment in patients with moderate to severe allergic rhinoconjunctivitis that has failed over-the-counter and several ophthalmic topical treatments."

"This is an interesting survey," said Stanley Fineman, MD, past-president of the American Academy of Allergy Asthma and Immunology and a member of that organization's ocular allergy committee. The research "clearly shows that it is difficult to differentiate true allergy-triggered eye symptoms and dry eye disease."

"We certainly see patients with overlap syndrome, but knowing the various factors that contribute to the inflammatory triggers is helpful for appropriate therapeutic recommendations," he told Medscape Medical News. "Allergists are specialists in finding triggers for inflammatory conditions."

Dr Leonard Bielory reports financial relationships with GlaxoSmithKline, Merck, Allergan, Alcon, Barr, TearLab, Shire, Dyax, Jerini, Genentech, Ista, Stallergenes, Bausch & Lomb, Valeant, SARCode, and the Environmental Protection Agency. Dr Brett Bielory has disclosed no relevant financial relationships. Dr Fineman reports financial relationships with Aerocrine, AstraZeneca, Genentech, Meda, Mylan, and Novartis.

American College of Allergy, Asthma & Immunology (ACAAI) 2014: Abstract 51. Presented November 10, 2014.

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