Spring allergy season in in full effect, and the combined warmer weather and pollen surges are taking no prisoners. An NBC news report recently described the experience of people residing in the northeast as a “Pollen Tsunami." The extended, cold winter created a greater overlap of spring and summer triggers, resulting in a double-barrelled shotgun blast of both tree and grass pollen.
In addition, tihs year I’ve noticed an escalation of complaints of eye allergy symptoms. Interestingly, instead of watery eyes being a major complaint, along with itching, burning and reddening, many patients are complaining about their eyes feeling extremely dry. Is there an explanation for dry eyes at a time where itchy eyes are accompanied by nasal allergy symptoms? I’m glad you asked.
Allergic conjunctivitis is the technical term for allergic inflammation of the eyes and impacts 70 to 80 percent of people who have allergic rhinitis (hay fever). Last month, researchers at the University of Miami reported on increased prevalence of dry eyes coordinated with high pollen counts. The report was published online in Ophthalmology, the journal of the American Academy of Ophthalmology.
The study reviewed about 3.5 million visits to VA clinics (Veteran Affairs clinics) over a period of 5 years. They also surveyed pollen counts over the same course of time using data recorded on pollen.com. Approximately 607,000 patients had a dry eyes diagnosis.
The article noted the dry eye symptoms were the highest in April, when pollen counts were high, and lowest during the summer. Winter was another time when patients had more complaints of dry eyes, but the investigators believe this is most likely not caused by allergies, but by indoor heating.
For many years, allergists thought dry eyes represented a separate condition from eye allergies. In allergy school, we learned to look for supporting symptoms of ocular (eye) allergies. They included: itching, watering, burning, reddening and puffiness or swelling of the eyelids. Dry eye symptoms didn’t make the list. However, I’m not surprised about these new findings, because so many people who have hay fever complain about dry eyes.
What causes dry eyes?The eyes require moisture and lubrication in order to put up with exposure to air, as well as the constant opening and closing of the eyelids while blinking. Tears and other glandular secretions help keep the eyes from drying out and getting infected. Healthy eyes require normal ocular epithelium (lining of the eyeballs), normal function of tear glands, and normal meibomian glands secretions (oil-containing substances that help to spread secretions evenly). Any process that disrupts the eyelids, the lining of the eyes, the tears, or glandular secretions can cause dry eyes and inflammation.
Once your eyes come in contact with allergy triggers, it causes a release of histamine and pro-inflammatory substances from mast cells located in surrounding ocular tissues (eyelids and other coverings of the eyeballs). The resulting inflammation disrupts the lining of the eylids and the consistency of the tears. Not only can this process cause watering of the eyes, but also dryness, associated with burning and a gritty feeling in the eyelids. Excessive tearing can occur when there is over compensation of tear glands in response to dry eyes.
Other situations and disorders associated with dry eyes include:* Dry eyes associated with** aging*** Dry eyes associated** with jobs that include gazing at computer** screens for hours (usually less blinking in these circumstances)
- Sjogren's Syndrome: A syndrome associated with dry eyes, mouth, and throat in addition to various joint and muscle problems.
- Dry eyes resulting from side-effects of medication* ** Infiltrating inflammatory** disorders (Sarcoidosis for example)
- Diseases of the eyelids that prevent them from properly functioning** What are treatment options?**** A thorough evaluation by an eye doctor is crucial for effective management of dry eyes. It is important to search for an underlying cause and address it directly.** Your doctor may ask you to see a specialist in order to address allergic or rheumatologic disorders. If conditions are severe, sometimes eye surgery to block the tear ducts is considered.
A common starting point for clinicians is to use a sterile moistening agent or wetting solution. There are many different brands found over the counter (OTC). It’s crucial to use the drops regularly, and not just when the eyes feel dry. Restasis is an FDA-approved eye drop for chronic dry eyes. This medication helps promotes tear formation, however it requires a doctor’s prescription.
Anyone can suffer from dry eyes depending on certain circumstances. In the winter, treatment may be as simple as adding humidity to your indoor air and using sterile wetting drops. But sometimes the problem requires further medical intervention. Start with getting an eye exam from an optometrist or ophthalmologist. Inform your primary doctor so that appropriate steps can be taken to look for underlying causes if indicated. If it is worse during outdoor allergy season, get evaluated by an allergist as soon as you can.