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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 Ocular Allergy vs. Dry Eye Disease • One signature of ocular allergy vs. dry eye dis- ease is the mild time delay from interaction with allergen to symptoms, including puffy eyelids, red eyes and tearing. • Allergic issues are typically confined to the bul- bar and tarsal conjunctiva. • Allergies may have concomitant systemic mani- festations, including rhinitis, dermatitis and respi- ratory maladies. For more, read "Is it Allergy or Dry Eye?" in Aug. 2012's OM (tinyurl.com/OMallergy). ClearChart® 4 · 4X · 4P Digital Acuity Systems Simple-to-use interface. 24-inch, LED backlit display. Custom developed for acuity testing. Made in USA. Pixel-perfect and purpose-built. © 2017 AMETEK, Inc. & Reichert, Inc. (1-2017) · Made in USA ClearChart is a registered trademark of Reichert, Inc. · www.reichert.com All-new! · SECO #1137 · reichert.com/clearchart oral antihistamine to provide further symptom re- lief. is combination of topical and systemic medi- cations addresses 75% of the cases of seasonal aller- gic conjunctivitis I see. Antihistamines can provide acute relief of redness and itching, while mast cell stabilizers can decrease or eliminate symptoms of an allergic attack when taken in advance (several weeks or more prior to allergy season). If the patient needs further improvement, I pre- scribe a topical steroid to be used two to four times daily. Antihistamines and mast cell stabilizers only address one aspect of the allergy cascade, but not the inflammatory cytokines, so steroids are sometimes needed. (See "Ocular Allergy Drugs," for a list of pharmacological options, p.17.) My last resort is to institute immunotherapy. Immunotherapy is treatment that uses your own body's defense system to help itself. Because I have identified, through allergy testing, what the patient is allergic to, I can prescribe the patient sublingual immunotherapy (SLIT) to be used at home daily to build up the patient's immune system. Basically, all things the patient is allergic to are reconstituted into drops that patients introduce into their bod- ies. rough the course of three to six months, the patient can administer drops under his or her tongue, which slowly through time, treats the underlying allergy and modifies the patient's im- PRIMARY EYE CARE PROVID- ERS ARE ON THE FOREFRONT OF TREATING ALLERGY.