dry eye dx and tx

Ayurveda Can Bring Sinus Relief to Some Allergy Sufferers

BY KATHERINE M. MASTROTA, MS, OD, FAAO

April showers may bring May flowers, but for many of your patients who suffer from allergies the buds of spring herald the start of another uncomfortable season. Dry eye sufferers are doubly vexed, coping with the allergic response of an already inflamed ocular surface that lacks sufficient tears to dilute and wash away allergens. Dry eye and allergy have similar symptoms, and often exist together. Clinical clues to the allergic response include itching of the eyelid skin or eye itself, a papillary reaction, and a teary eye, perhaps with mucus, as opposed to one with an obviously thin tear prism.

Symptoms Beyond the Eye

It is not uncommon for patients who have allergic, itchy, red, and watery eyes to concomitantly experience an allergic response of the nasal mucosa, or allergic rhinitis. Rhinitis is an inflammation of the nasal membranes and is characterized by a symptom complex of any combination of the following: sneezing, nasal congestion, nasal itching, runny nose (rhinorrhea), postnasal drip, and/or itchy ears, nose, palate, and throat. Allergic rhinitis is the most common cause of rhinitis. Common nasal and ocular allergens include pollens, molds, dust mites, and animal dander.

Medical treatments for rhinitis include antihistamines, anticholinergics, anticholinergics, mast cell stabilizers, corticosteroids, and decongestants delivered locally or orally. Of course, many of the orally administered medications have unwanted side effects on the ocular surface.

Natural Treatment for Rhinitis

Nasal irrigation (also referred to as nasal bidet, nasal lavage, saline lavage, saline irrigation, or jalaneti) is a hygiene practice in which the nasal cavities and sinuses are rinsed with warm isotonic or hypertonic saline solution to flush out excess mucus and debris and to moisturize the nasal cavity mucous membranes. Nasal irrigation has been practised for hundreds of years by yogis (yoga practitioners) in southeast Asia, where the practice is known as jala-neti. The practice of jala-neti is part of hatha yoga and the Ayurveda system of traditional medicine.

Saline sinus rinses can bring relief to patients who have chronic sinus or rhinitis problems and can prove to be a useful adjunct or alternative to existing medical therapies. Nasal lavage is helpful in removing and/or thinning secretions, flushing away irritants and microbes, and removing allergens that can trigger allergic rhinitis. Additionally, nasal irrigation may decrease inflammation through the removal of mucus and improve mucociliary clearance, which is an important defense mechanism against inhaled pathogens. Defective mucociliary clearance predisposes the respiratory tract to recurrent infection, manifested by chronic sinusitis.

Several over-the-counter sinus rinse devices are available, the most recognizable being the "Neti Pot." A Neti Pot resembles a "genie lamp," which is filled with saline and used to direct solution flow of the saline rinse. Instructional videos for nasal lavage can be viewed online from a number of sources. The American Academy of Asthma Allergy and Immunology's Web site posts a "Saline Sinus Rinse Recipe" available at www.aaaai.org/patients/publicedmat/sinusitis/rinse.stm.

Allergic patients for whom I have recommended nasal lavage are pleased with the results. The possibility of controlling allergic rhinitis with focal therapy and avoiding the side effects of oral medication can bring relief to your dry eye/allergic patients. Give it a try! CLS

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Dr. Mastrota is secretary of the newly formed Ocular Surface Society of Optometry (OSSO). She is center director at the New York Office of Omni Eye Services and is a consultant to Allergan, AMO, B+L, Inspire, Noble Vision, and Cynacon Ocusoft.