Dr. Ștefan Oprea, ophthalmologist: “We live in an extremely polluted environment and we cannot avoid allergies” INTERVIEW

Spring is allergy season, and from year to year, the number of patient cases has increased considerably. Itching, sneezing and excessive tearing are just some of the specific symptoms of allergies – whether we're talking about pollen, pollution, dust or animal hair – and the eyes are the most affected.

Dr. Stefan Oprea about eye allergies Sursa foro Adevărul

Ophthalmologist Ștefan Oprea explained to “Weekend Adevărul” what are the steps we must follow when we face such symptoms – from a first consultation to annual treatment.

The doctor also explained what the differences are between allergic and bacterial conjunctivitis, how a simple allergy can cause an over-infection in the eyes, but also why it is important that people suffering from such allergies go to both the ophthalmologist and to the allergist.

“Weekend Truth”: What are allergies? What happens in our body that we end up developing eye allergies?

Dr. ANDTefan Oprea: Allergies mean a hypersensitivity reaction of our immune system that overreacts to certain stimuli. Unfortunately, it is something that cannot be avoided and the treatment is exclusively symptomatic. Of course, certain desensitizations can be tried, but this time at the allergist.

There is nothing we as ophthalmologists can do about it. But it is important to specify that it is not with a guaranteed success rate. They try – sometimes they succeed, sometimes they don't. The unpleasant part about this is that you cannot be sure that you are completely free from allergies.

Is there a certain age at which eye allergies appear?

You can have no allergies until you are 50, for example. And then, you find yourself having an allergy to something to which you were not allergic until that moment, whether we're talking about pollen, whether we're talking about fluff, or something from the atmosphere, or a certain dermato-cosmetic product that you -you used and which did not create any kind of problem for you up to a certain point.

It is a real challenge to explain to the patient who comes with a complaint about the health of the eyes that is eating at him, that is making him tear up. You give the diagnosis of allergic conjunctivitis, for example, and he looks at you like that, skeptical “how, since I'm not allergic, I've never been to anything”. Unfortunately, there is a beginning.

Microscopic differences

We can say that allergies are out of control at this point…

We live in an extremely polluted environment and we cannot avoid allergies, and this is not only true in Bucharest, but also in apparently healthier cities, because you have nothing to do but somehow avoid exposure.

For example, ragweed, which is somewhere closer to autumn, has very fine particles of pollen that can travel, ending up causing allergies in people in urban areas, where they know that this plant would be prohibited even many kilometers around the cities.

prhymea is the season the pollenIU. What are the symptoms of these eye allergies and if at some point they get confused, the patient thinking maybe he has a cold?

Most are used to it, as pollen allergies recur every year, with their symptoms: excessive watering and itching, most often. At the bio-microscope, we, the ophthalmologists, also notice some specific changes in the conjunctiva, but this analysis is necessary to make a diagnosis with certainty.

Whether we have bacterial conjunctivitis, viral or allergic conjunctivitis, it looks different and we can tell from the microscopic appearance if it has a predominantly or exclusively allergic component.

From allergy to super-infection

The patient feels tearing and itchingme, but can these symptoms get worse?

Just as well, this conjunctivitis can also become bacterially or virally super-infected, depending on the situation in the local flora, and generate a bacterial conjunctivitis over the purely allergic reaction. For this reason, it is good for patients with symptoms to come to the ophthalmologist for an evaluation, to see if it is purely allergic and at that moment we simply treat the allergy, or, if it is also a bacterial superinfection, we also add an antibiotic.

I mean, a simple speck of dust or pollen that gets into my eye can also cause an infection?

Not necessarily. This can happen at any time during the year, if something gets in the eye. Simply in the local flora – there being a sensitive area -, when the allergic conjunctivitis began to manifest itself, if we hit it by mistake, later we will see that secretions appear.

Serious conditions are rare

pthe foggy river, the light of the chariote

do you mind if they are also part of this painting?

Mostly, yes. If we have hyperlacrimation, we basically have more tears, which flow, or sometimes not, and a thicker film forms. Some patients believe that they have noticed from their own experience that if they squeeze again or if they rub their eyes, then they see better. It is not about a decrease in vision in real terms, i.e. a clouding of the lens, for example, which is almost always irreversible, or problems in the cornea. But indeed, because of this hyperlacrimation, blurred vision can occur.

Is conjunctivitis the only condition caused by allergy?

In principle, it is the form that we encounter most frequently. Corneal conditions can also occur in this context, in more aggressive reactions, but very rarely. However, if managed well from the beginning, allergic conjunctivitis does not progress further with the conditions. When she's allergic, we treat her as such.

If we see an infection, we evaluate that diagnosis and treat it accordingly. They can also be combined. But it can also be contact conjunctivitis, for example with inappropriate makeup, with an inappropriate shampoo or cream, or simply something that was not for ophthalmic use.

QCan it happen to contact lens wearers?

Allegia is said a lot, but it's giant-papillary conjunctivitis and practically you can't wear contact lenses any more after that. This is also a hypersensitivity reaction. There are also other types of allergies, and for this reason the patient must talk to the doctor. Maybe you're not allergic to pollen, but you've changed your office, or there's something wrong with your air conditioning system, for example. I have had many patients who developed such allergies after moving house, after going on vacation. That is why timing and changes are very important for a correct diagnosis.

The ophthalmologist, hand in hand with the allergist

How is the diagnosis made?

The diagnosis is made only at the doctor, where he presents all the symptoms he has, without omitting anything. And then we confirm the diagnosis through consultations. More precisely, during the consultation, we perform the bio-microscopic examination – when we look at the eye with the light, under the microscope, and practically make the diagnosis.

If you have already made the diagnosis, is it still necessary to visit the allergist?

I recommend that every time a visit is also made to the allergist to check the diagnosis. I have no doubt when I make the diagnosis, but the allergist is important to identify the cause, because I cannot tell if you are allergic to pollen or if you are allergic to something else in the atmosphere.

Basically, here the allergist should help us, do the specific tests and try a healing treatment, unlike me who give a symptomatic treatment. Again, there is nothing guaranteed, like with an infection, where it is very clear that you can treat it and cure it completely. In the case of an allergy, it is not like that – often we only go symptomatically, often allergists also only go symptomatically or fail with the healing part.

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How to treat DECIDES?

We must have a close dialogue with the allergist, because what we do in ophthalmology is purely symptomatic. I give the patient a topical treatment, mainly, that is, specific drops for allergies, which help him to reduce the manifestation. It is often not enough. I can also give him some artificial tears to create a protective film for him, these have some fixing properties on the ocular surface that prevent rapid evaporation, especially for those who work on the computer – they form a kind of protective barrier including against allergenic factors in the atmosphere.

Some types of artificial tears also have an anti-allergic component that helps additionally. Also, there are some situations in which the prescription of pills is necessary – if it is a more aggressive, allergic reaction in the eye, we can also associate some oral antihistamines.

You know the general behavior of the patient very well. In Romania it he quickly goes to the pharmacy for something to calm him down. What advice do you give them though, in pharmacies you can give drops that do more harm?

I can do more harm. I have many patients in this situation. I explained to them that when you buy a commonly prescribed, commonly recommended drug that has an antibiotic and a steroid anti-inflammatory, and they use it when it bothers their eyes, it can make them very sick.

It can increase eye strain, not to mention develop antibiotic resistance, and when they really need it, that drop won't work. Because of the lack of information, you can develop a resistance to antibiotics. I have noticed that some patients undergo a treatment that causes vasoconstriction (no – contraction of smooth muscle fibers in the walls of blood vessels, resulting in a decrease in vascular caliber). They apparently feel fine, the eye looks good, it's not red and it's lubricated.

But what the patient doesn't know is that those drops have the same effect as the nasal drops which are addictive if used too much. It doesn't treat, it doesn't cure anything, not even symptomatically. For this reason, they can be given without a prescription. If you have a bad allergy, that drop doesn't help at all, maybe just a few minutes.

For this reason it is important that the patient comes to the doctor, even if he knows that he has experienced this every year and received perhaps the same treatment that worked well for him. A check-up, eye pressure measurement, fundus check are required. The doctor must determine whether the patient can still receive the same treatment, if no changes have occurred.

Desensitization, a long shot

Is it possible to prevent these eye allergies though?

We can only prevent those that are contact. For example, if you are allergic to pollen, there is no way to prevent contact with it. Same with pollution – you can't avoid it. On the other hand, if you are allergic to animal hair, you can prevent, you can give up the pet – of course, 92% of patients don't give up and stay with the treatment, it seems natural to me, you get emotionally attached.

So, unfortunately, at the current level of knowledge, no clear solution has been found. Allergists are trying their best, but there is no clear guarantee that a cure will be found. There are desensitization treatments, they try – sometimes they succeed, sometimes they don't.

What advice do you give in case though

allergiestheir spring eyepieces?

I would put plenty of artificial tears during this period, especially the ones I was talking about, which also have an anti-allergic component, protect and somehow delay the onset of more aggressive symptoms. Later, if we passed this phase and allergic conjunctivitis appeared, let them come to the ophthalmologist, make an appointment with the allergist, make an appropriate treatment plan for them at this time because super-infections can also occur, and things can get complicated.