Optometric Management

FEB 2017

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16 F E B R U A R Y 2 0 1 7 • O P T O M E T R I C M A N A G E M E N T . C O M FEATURE ANNUAL MEDICAL SERVICES ISSUE IDENTIFY THE ROOT CAUSES OF ALLERGIC CONJUCTIVITIS TO PROVIDE PATIENTS WITH RELIEF ITCHING FOR BASEBALL SEASON Jason Schmit, O.D. Sioux Falls, S.D. I N SPRING, we get to see the world come alive again. It's a time for new possi- bilities, where anything can happen, for example, a fresh start for your favorite baseball team and a path to the World Series. But, with spring training, comes allergy season. "Worldwide sensitization rates to one or more common allergens among school children are currently approaching 40% to 50%," according to the American Academy of Allergy, Asthma & Immunol- ogy. Some other data suggest that ocular allergies in the adult population worldwide are at 15% to 20%. As primary eye care providers, we are on the forefront of diagnosing and managing these pa- tients. Here, I discuss how to diagnose and manage allergic conjunctivitis. DIAGNOSIS View allergy — or allergic conjunctivitis — as a diagnosis of exclusion because many of the allergy symptoms patients experience, such as itching and burning, can be similar to dry eye disease (DED) or, possibly, an infection. Rule out those conditions be- fore instituting therapy for allergies. (See "Trigger- ing the Cascade" p.21 and "Ocular Allergy vs. Dry Eye Disease" on p.19.) Next, determine the suspected allergen or allergens. Gathering a comprehensive case history is a must to achieve this. Ask the patient when symptoms began, how long they last, if symptoms are progressing and whether they're worse while outdoors vs. indoors. Also, inquire about other modifying factors, such as whether symptoms increase when at school/work but are better when at home; itching is not as severe when visiting family in Florida vs. at home in South Dakota, etc., and the quality or severity of symptoms. is provides the necessary background information needed to address patient complaints. Now, test patients for allergies so you can address the root causes. I use the Doctor's Allergy Formula system (Bausch + Lomb) that tests for 60 specific ocular allergies, both indoor and outdoor. (Out- door allergens are unique to the region of the U.S. in which you live.) e scratch test takes three minutes to administer on the patient's arm, and results are determined in 15 minutes. A caveat: Patients' sys- tems need to be clear of any antihistamines and some tricyclic antidepressants, such as amitriptyline, for about five to seven days before administering the test, or you won't get a true result. is specific test is typically covered by most major medical insurances, according to the Bausch + Lomb website. MANAGEMENT e first treatment solution in allergy management is avoidance. You can't get resolution for someone who is allergic to cats if he or she sleeps with a cat every night, for example. Once you find out what the patient is allergic to, try to incorporate avoidance

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