Spring into Action: Managing Allergies in Optometric Practice!

In Canada alone, one in four individuals suffer from allergies, with 40% of those cases attributed to pollen [1]. As pollen levels continue to rise in major Canadian cities [2], the prevalence of seasonal allergies—and their impact on ocular health—is expected to grow. This highlights the growing demand for effective management strategies.

Role of Optometrists in Managing Ocular Allergy Symptoms

Ocular allergies result from the immune system reacting to foreign particles such as pollen, pet dander, and dust mites. Exposure to an increase in allergens may surpass the threshold and trigger an inflammatory response.  

One of the most common features of ocular allergies is pruritus (itching), which in rare cases, may even be painful. [3] Other common symptoms can include tearing, foreign body sensations, eyelid swelling, and mucous discharge. [4] 

Despite the prevalence of ocular allergies, many patients do not tend to seek professional care. In a European study, over 50% of patients who were diagnosed with ocular allergies opted to self-treatment: washing eyes with water/saline and using medications at home. Only roughly one in five sought professional help. Those affected with allergies reported lower quality of life and higher rates of absenteeism from work or school than healthy individuals. [5] 

This underscores the important role of optometrists in identifying and addressing ocular allergies of their patients within a clinical setting. As the primary eye care providers, optometrists can help bridge the gap between symptoms and effective treatment options directly in their chairs! 

Preventative Measures: Minimizing Exposure and Protecting Eye Health

Simple, practical steps may be taken to help reduce allergen exposure and prevent symptoms from worsening for your patients.  

• Minimize Allergen Exposure: Advise patients to keep windows closed during high pollen seasons, use air purifiers, and wear glasses/sunglasses outdoors to reduce direct contact with allergens.
• Maintain Proper Eye Hygiene: Encourage regular eyelid cleansing to remove allergens from eyelashes and reduce irritation.
• Use Lubricating Eye Drops: Preservative-free lubricant drops can help wash away allergens and provide comfort throughout the day.

Treatment Options: Addressing Allergy Symptoms Effectively

Traditionally, oral antihistamines and mast cell stabilizers have been common choices for allergy relief amongst patients and health professionals for its convenience. While these oral tablets may be effective, they may have unwanted side effects such as drowsiness and dryness of the eyes and mouth, especially with first-generation ones. [6] 

For moderate to severe cases of allergies, modern day prescription allergy eye drops such as olopatadine and ketotifen offer both antihistamine and mast cell stabilization properties. [7] Although effective in allergy relief, these may cause potential side effects such as dryness, blurred vision, and burning/stinging. [8,9] Additionally, preserved formulations may exacerbate ocular surface irritation over long-term use [10], and cost barriers without insurance can limit access for some patients. 

An emerging alternative for ocular allergy management is ectoine-based lubricating eye drops. Ectoine, a natural molecule with water-binding properties forms a protective barrier over the tear film, helping to shield the eyes from allergens and reducing inflammatory responses. [11,12] 

Ectoine-based lubricating eye drops are available in preservative-free formulations, directly available in optometry clinics. This offers an accessible option for patients seeking allergy relief. Some formulations also contain high molecular weight Sodium Hyaluronate, which provides long-lasting lubrication—addressing both allergy and dry eye symptoms in one drop. 

Since treatment needs vary, discussing the benefits and limitations of each option with patients ensures the most suitable choice for their needs.

Empowering Patients to Take Control of Their Eye Health

With expert guidance, optometrists can help patients manage ocular allergy symptoms more effectively, improving both comfort and quality of life. Regular consultations and tailoring treatment approaches reinforces the indispensable role of optometrists in long-term ocular health. 

Through proactive care, optometrists not only enhance patient well-being, but also foster trust within their practice. As allergy season intensifies, optometrists are well-positioned to help improve the ocular health and patient-centered allergy management. 

References: 

1. Brule S, McDiarmid C, McDonald H. Health Fact Sheets Chronic Conditions, 2017. [Internet]. Government of Canada, Statistics Canada; 2018 [cited 2025 Mar 11]. Available from: https://www150.statcan.gc.ca/n1/pub/82-625-x/2018001/article/54983-eng.htm 
2. Pelley L. ‘I actually had to call in sick’: Why seasonal allergies are getting worse for city dwellers. CBC News [Internet]. 2019 August [cited 2025 Mar 11]. Available from: https://www.cbc.ca/news/canada/toronto/cities-seasonal-allergies-symptoms-worsening-climate-change-1.5256496
3. La Rosa M, Lionetti E, Reibaldi M, Russo A, Longo A, Leonardi S, Tomarchio S, Avitabile T, Reibaldi A. Allergic conjunctivitis: a comprehensive review of the literature. Ital J Pediatr. 2013 Mar 14;39:18. doi: 10.1186/1824-7288-39-18. PMID: 23497516; PMCID: PMC3640929.
4. Bielory L. Allergic and immunologic disorders of the eye. Part II: ocular allergy. J Allergy Clin Immunol. 2000 Dec;106(6):1019-32. doi: 10.1067/mai.2000.111238. PMID: 11112882.
5. Palmares J, Delgado L, Cidade M, Quadrado MJ, Filipe HP; Season Study Group. Allergic conjunctivitis: a national cross-sectional study of clinical characteristics and quality of life. Eur J Ophthalmol. 2010 Mar-Apr;20(2):257-64. doi: 10.1177/112067211002000201. PMID: 20037906.
6. Ousler GW, Wilcox KA, Gupta G, Abelson MB. An evaluation of the ocular drying effects of 2 systemic antihistamines: loratadine and cetirizine hydrochloride. Ann Allergy Asthma Immunol. 2004 Nov;93(5):460-4. doi: 10.1016/s1081-1206(10)61413-5. PMID: 15562885.
7. Ben-Eli H, Solomon A. Topical antihistamines, mast cell stabilizers, and dual-action agents in ocular allergy: current trends. Curr Opin Allergy Clin Immunol. 2018 Oct;18(5):411-416. doi: 10.1097/ACI.0000000000000473. PMID: 30020258.
8. Drug and Health Products Portal [Internet]. Consumer Information for: KETOTIFEN OPHTHALMIC SOLUTION – Drug and Health Products Portal; [cited 2025 Mar 13]. Available from: https://dhpp.hpfb-dgpsa.ca/dhpp/resource/88567/consumer-information
9. Drug and Health Products Portal [Internet]. Consumer Information for: SANDOZ OLOPATADINE – Drug and Health Products Portal; [cited 2025 Mar 13]. Available from: https://dhpp.hpfb-dgpsa.ca/dhpp/resource/84395/consumer-information
10. Baudouin C, Labbé A, Liang H, Pauly A, Brignole-Baudouin F. Preservatives in eyedrops: the good, the bad and the ugly. Prog Retin Eye Res. 2010 Jul;29(4):312-34. doi: 10.1016/j.preteyeres.2010.03.001. Epub 2010 Mar 17. PMID: 20302969.
11. Salapatek AM, Werkhäuser N, Ismail B, Mösges R, Raskopf E, Bilstein A. Effects of ectoine containing nasal spray and eye drops on symptoms of seasonal allergic rhinoconjunctivitis. Clin Transl Allergy. 2021 Mar;11(1):e12006. doi: 10.1002/clt2.12006. PMID: 33900046; PMCID: PMC8099269.
12. Dwivedi M, Backers H, Harishchandra RK, Galla HJ. Biophysical investigations of the structure and function of the tear fluid lipid layer and the effect of ectoine. Part A: natural meibomian lipid films. Biochim Biophys Acta. 2014 Oct;1838(10):2708-15. doi: 10.1016/j.bbamem.2014.05.011. Epub 2014 May 17. PMID: 24841755.