Leonard Bielory, MD
1. Incorporate skin testing to confirm specific allergen sensitivity (perennial vs. seasonal) because that commonly differentiates type of allergy. Seasonal allergy patients are more severe than perennial.
2. Understand the overlap between allergies and tear film dysfunction (âdry eye patientsâ) and the use of antihistamines that have anticholinergic activities (essentially all antihistamines have muscarinic and anticholinergic binding activities).
3. Patients on hormone therapy for various reasons (polycystic ovarian dysfunction, birth control pills, cancer treatment regimens, etc.) have alterations in their tear films that increases their tear osmolarity and ocular symptoms consistent with tear film dysfunction.