As optometry's scope of practice has increased, optometrists have embraced allergic eye disease. Ocular allergies have multiple effects to patients in our practice. But, if allergies are unidentified because symptoms may not be present during office visits, patients may treat themselves. This leads to patients taking advice from friends and family members on what they think they should be using to treat their symptoms or looking to over-the-counter (OTC) products.
Some topical OTC agents contain vasoconstrictors which have the potential for abuse and rebound hyperemia. Plus, overusing these products can cause keratitis. Contact lens-wearing allergy sufferers present an additional logistical challenge to appropriate treatment. Often these individuals are using products that are not approved to be used with contact lens wear. This can even further exacerbate their symptoms.
With all of the potential sequalae with those who treat themselves with topical OTC products, it is critical to identify these individuals when they are in the office and guide them to appropriate treatment options. If they come into their appointments symptomatic, it is relatively easy to identify them as allergy sufferers. But, if they come in to see you in the winter and their allergy symptoms are present in the spring and fall, they may not seek your advice on appropriate treatment options when symptomatic.
Probe deeper for allergy symptoms
Identifying individuals who may be symptomatic for allergic eye disease requires uncovering symptoms that patients may have at other times throughout the year. Make sure that the medication list that you have for your patients is current. Probe for more details about medications that patients may take as needed. We ask patients if they take any medications throughout the year, even if they are non-prescription products.
Additionally, if no medications are recorded in the chart, I will often ask, “Do you ever use allergy medications at any time throughout the year?” Frequently, this question will elicit a positive response for OTC allergy medication. Then I will engage the patient to discuss ocular symptoms. Asking the question to prompt a discussion will allow you to appropriately educate the patient on how to proceed with managing his allergies by providing a therapeutic agent or advising a return visit to assess ocular tissues and symptoms during an allergy flare.