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    Allergy or dry eye: Which is it?

    Listening to patient complaints a good start, followed by using signs and symptoms to sort through primary etiology

    Bowie, MD—Even the most experienced ophthalmologists sometimes have to exert extra effort to ascertain if a patient’s complaints of ocular discomfort arise from dry eye, allergies, contact lens problems, or a combination of chronic and seasonal issues.

    “It can be almost impossible to separate the myriad, multifaceted rationales for someone’s current ocular surface state,” said Jonathan Solomon, MD, who is in private practice in Bowie, MD. “There can be a little bit of allergy going on, a little bit of dry eye, some occupational component, and in addition maybe some aqueous deficiency due to an underlying autoimmune disorder.”

    Related: When old, new technologies converge for dry eye diagnosis

    “It’s sometimes better to look at things globally with an understanding of the different causes but to treat systemically and with a willingness to dabble in it all,” he added.

    Starting point

    Dr. Solomon prefers to start with simple homeopathic remedies and then move on, as needed, to medication.

    When obtaining the history before the examination, the focus should be on the primary complaint or chief concern and getting detailed information, Dr. Solomon said.

    Consider the time of year, the patient’s home and workplace environments, any recent travel, comorbidities, and other medications.

    Related: What punctal plug delivery of dexamethasone means for allergic conjunctivitis

    “This helps identify a number of features that may contribute to inflammation or irritation on the ocular surface,” Dr. Solomon said.

    One diagnostic tool he recommends is a point-of-care test (Doctor’s Allergy Formula, recently acquired by Bausch + Lomb) that uses a panel of 60 regionally specific allergens. The test includes outdoor, indoor, and seasonal allergens and can be updated.

    Looking for clues

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