Q&As with Dr. Pukl about Allergies
Question: What are the most common symptoms of allergies?
Dr. Pukl: The most common symptoms are itchy, watery eyes, swollen eye lids, coughing, sneezing, wheezing, congestion, and runny nose. In addition, some people experience rashes on the skin in different areas of their body.
Question: How do allergies directly affect the eyes?
Dr. Pukl: Most common is itching of the eyes. Other eye symptoms are heavy swollen eye lids, the white part of the eye gets red and irritated, and can look almost clear.
Question: What is allergic conjunctivitis?
Dr. Pukl: This is when the mast cells release histamines, and triggers an allergic response in the eyes, which is the redness, swelling, itchiness in the eyes.
Question: Is allergic conjunctivitis the same as pink eye?
Dr. Pukl: No. They are very different. With allergic conjunctivitis, the mast cell is releasing the histamine in response to the allergen in the air that the patient is sensitive to, and this is not contagious. Even though Pink Eye has a lot of the same symptoms, the eye is typically less itchy and more irritated, sore and with a sandy feeling. Additionally, Pink Eye has more watering and discharge from the eye, and is an infection caused by a virus or bacteria and can be contagious.
Question: If I have an allergy to something and the symptoms are in my eyes, I can also experience symptoms in other parts of my body. What does this have to do with my optometrist? Wouldn't I just need to go to an allergy specialist?
Dr. Pukl: A large percentage of allergy sufferers also have allergic conjunctivitis, and while most people may be able to find cure in a basic antihistamine from their allergist, others have really severe allergies where they need something stronger, such as a steroid. Once someone begins steroid treatment, they should be managed by an optometrist or ophthalmologist, because steroids can cause glaucoma and cataracts when they are used long-term.
Question: Typically, a patient comes to you saying, "I have something in my eye, what is it?" and you see that they have allergies, or do patients with allergies usually come to you from a referral from an allergist or physician?
Dr. Pukl: Most of the time we see patients for their routine eye exam or they wake up and their eyes are really red and swollen and itchy, and they come in to see us on their own. They think they may have Pink Eye. The real difference between coming to see us, as opposed to their physician or allergist, is that we have a slit lamp. This is a special microscope with a very high-intensity light that focuses a thin sheet of light into the eye. It is used in conjunction with a biomicroscope. This allows us to get a much closer look at the tissues of the eye. We see all parts of the eye under high magnification and really explore the tissues of the eye and are able to identify some of the very subtle nuances between causes of conjunctivitis and allergic conjunctivitis, and also be able to grade it in terms of severity at a much more accurate level.
Question: How do you determine if I'm having an allergic reaction?
Dr. Pukl: It's case by case, but allergic conjunctivitis is one of the most common things we see. Typically, when we are told the symptoms and we have a full case history and a complete eye exam, we can tell right away what it is. Allergies are usually more chronic in nature, however sometimes they come on acutely. We look at the patient's history to help us make the determination. We might see that the patient touched something or came into contact with something, or that when they woke up in the morning both of their eyes were swollen shut. It's pretty obvious from those signs and symptoms that it's allergic vs infection. With Pink Eye it's more likely that the patient has had a cold or virus for a couple of weeks, or his sister or mother had Pink Eye and now his eyes are red and irritated also.
Question: Does it ever happen that the patient comes for a regular eye exam and they are not aware of any allergies they have, and you tell them that you see they are allergic to something?
Dr. Pukl: Yes. I will see they have allergic conjunctivitis and tell them, and they will say "Oh yeah, I did get a new cat recently" or "you are right, they have been bothering me lately" and things like that.
Question: What is the difference between seasonal and perennial allergies?
Dr. Pukl: Seasonal allergies are seen in the spring and summer and usually an immune response to the pollen from trees, weeds, plants and flowers. The perennial allergies are present year-round or flare up only when you come into contact with certain things that are around all the time. The most common perennial allergies are to dust mites, animal dander, and different molds and fungi.
Question: Can allergies do any permanent damage to my eyes?
Dr. Pukl: Yes. In certain instances, where the conjunctivitis is severe, it may involve the cornea, which can get scarred. In addition, allergic dermatitis, which is when the skin around the eye lids is irritated and someone is rubbing it constantly, has been frequently associated with keratoconus, a conical thinning of the cornea which can cause vision loss.
Question: What treatments are there for allergy sufferers?
Dr. Pukl: It all depends on the severity of the allergies. First and foremost we want to educate the patient and identify the allergen and see if they can avoid it. However, for seasonal allergies, you can't just stay indoors for half the year. This is when treatment options are presented. For the mild cases, you can flush the eyes with artificial tears, or use cold compresses or ice packs to provide relief of the symptoms. If it's more advanced, my favorite drops are combination drops, which are a mast cell stabilizer - an antihistamine. This drop is great because it works in two ways: #1 it provides immediate relief from the symptoms of itching, redness and irritation, and #2 when it's used properly it actually helps to prevent these symptoms in the future because it stabilizes the mast cells and it no longer releases histamines.
In more sever allergy cases we will go straight to a steroid, which provides immediate relief of the inflammation, but we are careful because these drops can be dangerous when used long-term, meaning more than six weeks. We manage these patients a little bit closer. I have two patients, who are pediatric patients, where chronic use of steroids is associated with more severe adverse reactions, so I have co-managed them with the ophthalmologist. This way, together, we minimize the number of steroids while keeping the patient comfortable.
Question: What demographics are more prone to allergies?
Dr. Pukl: The elderly and people ages 20 years and younger constitute about 20% of allergy sufferers. From 19 years to 40 years old is the bulk of the allergy sufferers.
Question: Does insurance cover office visits and treatment for allergies?
Dr. Pukl: Yes. Almost all medical insurance will cover the office visits and treatment of allergies.
Question: Is there anything else you would like to tell us?
Dr. Pukl: We have a big staff and we are open six days a week, day, night and weekends, and we are really here to accommodate anyone who may have any signs or symptoms of allergies. Please call us and make an appointment.