Article Date: 9/1/2001

Fix It Yesterday!
Athletes and ocular allergies.
BY SUE LOWE, O.D., F.A.A.O., F.C.O.V.D.,
Laramie, Wyoming

When certain athletic patients are exposed to an allergen, hyperemia, tearing, itching and conjunctival chemosis result. These allergic symptoms interfere with vision, attention and reaction.

Athletes often have a "fix it now" mentality. They need to be able to perform in dust, wind, sun and different playing fields in different locations. What should you do?

Here are steps you can take.

Find out exactly when, where and how their eyes are bothering them. If a patient complains of allergies, prioritize his symptoms. If he says the one that bothers him most is itchy eyes, it's probably an allergy problem.

While taking case histories during a routine exam, I ask the athletic patient if he's ever experienced allergy signs and symptoms during play. If he says "yes," I have him return to my office before his next athletic season, if possible. If these patients can use mast cell inhibitors b.i.d. or q.d. before they become symptomatic, they may not become symptomatic at all.

It's crucial that you properly diagnose and grade the signs and symptoms of edema, redness, papillae and itching so you know what treatment is best and how bad the symptoms are. You can compare your patient's subjective report at his next visit to see if he's improved. Also, keeping good records can help you if any malpractice issues arise later.

Educate the patient. Usually, it's impossible to totally eliminate or cure an allergy. Advise the patient about allergens he should try to avoid (pollen, animal dander, dust). Avoidance is difficult outdoors, but wraparound ski goggles that fit close to the face can help.

Ask about previous allergy treatments he may have undergone and whether he suffered systemic side effects. Has he had allergy shots?

Most of my patients believe that "knowledge is power." Therefore, I spend time explaining the allergen cycle, the hierarchy of treatment and which I recommend first.

Choose a treatment. I give patients samples of artificial tears (Refresh, HypoTears, Moisture Eyes, GenTeal, Bion Tears) to use at least six times per day to remove the antigens from the eye surface. This treatment will do no harm and often helps.

I may also prescribe a mast cell inhibitor with an antihistamine agent for mild-to-moderate allergies, and both topical and oral medications for moderate-to-severe cases. I also use mild steroids and drugs like ketotifen fumarate (Zaditor), olopatadine HCl (Patanol), ketorolac tromethamine (Acular), emedastine difumarate (Emadine) and levocabastine HCl (Livostin).

Sports goggles. Ski goggles may help a patient with eye allergies. The American Optometric Association is a great resource for information on eye allergies. You can contact them at (1-800) 365-2219.

Remember, if you can help your athletic patient maintain clear, comfortable vision, he'll be your patient for life. Not only that, but he's bound to refer new patients to you. OM

Dr. Lowe practices at Snowy Range Vision Center in Laramie, Wyo. She was elected into the National Academies of Practice in 1999 and is chair-elect to the Sports Vision Section of the American Optometric Association.


Not Like Us

Children react differently to allergy medications.

Antihistamines such as diphenhydramine (Benadryl) and loratadine (Claritin) are known to make adults sleepy, but a recent study at the National Jewish Medical Research Center found that they didn't have the same effects in children. In a study setting designed to mimic a real school as much as possible, students taking diphenhydramine or loratadine scored as well on tests as children who had taken a placebo. The study authors say these results reinforce the need to study the effects of drugs on children before approving them for pediatric use.


Optometric Management, Issue: September 2001