For the past few weeks I have seen increasing numbers of patients here at Miami Eye Center complaining of red, itchy eyes.  Known as allergic conjunctivitis, this set of symptoms afflicts millions of Americans.  The condition doesn’t lead to loss of vision but it surely can impact your quality of life.  Folks who have lived here in Miami for any period of time know that there is always some tree that is blossuming with the potential threat of an allergic attack.  Recent arrivals are always surprised when their allergy season begins long before it used to when they lived elsewhere.

The first thing that should be understood is that the allergic reaction represents a complex casscade of biological events initiated by the allergen which sets off the response.  It is for this reason that eye whitening drops such as Visine and similar products (vasoconstrictors) will not have an effect on improving the symptoms.  This class of drops  constricts the small blood vessels on the surface of the eye and makes it look whiter.  Once the effect of the drug wears off, there is a rebound and the eye gets even more red than in the first place; you get into a never ending spiral.  Probably worse than vasoconstrictors is taking oral Benedryl which seems popular in Miami.  This drug will put you to sleep and perhaps that will relieve your symptoms but it will have no effect on the conjunctival reaction.The solution to your problem lies in the interruption of the allergic cascade that causes the swelling, itching and reddness.  It has been my observation that getting allergy tested has no place in the management of allergic conjunctivitis.  Firstly, the tests will not reveal the specific allergen causing your problem and secondly, even if the allergen is discovered there is no method of desensitizing yourself for allergic conjunctivitis as you might for other allergies.

The itchy eyed patient needs to obtain a product such as Pataday, Zaditor, Elestat or Lastacaft which are prescription items.  These drugs specifically interupt the release of histamine along with suppression of other biochemical reactions.  These drops have few side effects and can be used over the long term. 

The “take home message” here is don’t waste your time with  over-the-counter allergy eye drops and get a sophisticated product.

Here in Miami and probably elsewhere, about half of my patients having cataract surgery also have dry eyes or eye allergies or various types of inflammation of the eyelids.  It is amazing to me how this problem can reduce the good results of well done cataract surgery (LASIK surgery as well).  In many cases the condition is only slightly bothersome prior to surgery, however, when you have cataract surgery with one of these ocular surface diseases present, there appears to be a surprising diminusion of the visual outcome.  If you have chosen to make a significant “lifestyle enhancement” with a multifocal lens insertion at the time of cataract surgery you want to maximize the result and achieve the ultimate potential of this new technology. 

During the preoperative examination at Miami Eye Center, we look at the tear film using new technology and are able to determine if you have a deficiency in the water component of the tear film or if your tears are evaporating too fast.  When found, patients are treated with artificial tears preoperatively and the surgery itself is performed in a way which protects the surface of the cornea.  If we find an inflammatory problem causing a tear film deficiency we treat that with a course of cortisone eye drops before the surgery.  We might also use Restasis to decrease inflammation. In cases of eyelid inflammation a round of oral antibiotics as well as antibiotic eyedrops over a period of several weeks can improve the tear film.

The take home message here is that there are subtle issues which can impact the outcome of your eye surgery that are beyond just having a good procedure and your surgeon needs to evaluate these factors and discuss them with you.