Dry eye after severe allergic reaction (hives) and oral steriod Rx

[mcleary]

I never noticed a dry eye issue, other than not having luck with contact lenses (started wearing August 2011) and giving them up (January 2012), but I felt fine without the contact lenses in. My dry eye problem "started" after I had a severe allergic reaction (July 1, 2012-ish) to a necklace (thought it was gold, turned out it's probably nickel) that caused really bad hives. Looked like I still had the necklace on. My Dr. prescribed oral steroids and said to take benedryl at night and other allergy medicine during the day...I wound up with Allegra. After I was done with the steroids, I continued with the benedryl/allegra combo during the day. When I felt good enough to stop the allergy medicine, I got itchy eyelids the very next day (really didn't noticed they were dry) and saw my eye dr, who determined I had 2-3% of normal tear production and meibobian gland dysfunction. Now I really am having trouble with my eyes not feeling good, taking drops multiple times/day, using thicker PM stuff at night.

Almost 2 months later, I'm still having the dry eye issue. Has anyone had any luck with this going away? It seems like it started with my allergic reaction. It should be going away now that the allergic reaction is gone. I don't have any hives on my neck anymore. Why do I have the dry eye issue? Has anyone had luck with making the dry eye issue go away in this situation? Should I see an allergy doctor? Should I see a different doctor? Is there such a thing as an autoimmune doctor?

Thanks,
M

[Scout]

In many medical studies (some of which I have posted in the medical literature forum), nickel is almost always the number one cause of allergic and or inflammatory reactions of the ocular surface or eyelids.

Unfortunately, if your ocular surface and eyelids reacted to the nickel exposure, it could take some time for the inflammation to subside. Sometimes when you have such a severe reaction to one substance, your body tends to be even more reactive to other substances and the cycle continues for weeks, even months. It was explained to me that allergies/sensitivities tend to be cumulative.

What you are describing happened to me and I made the mistake of treating my eyes to regular eye drops (both wetting and allergy drops) and the allergic/inflammatory process continued for a long time because my eyes were then reacting to the drops I put in my eyes. So I was doing what I thought would help and in fact, I was making the reaction worse. Stopping all drops and then making sure I removed other substances and chemicals in my environment (lotions, fragrance, soaps, etc, etc) that I was now reactive to (because the ocular surface and eyelids were so oversensitive) helped me the most.

But it does take time. Longer than I would have liked.

If you want to see a doctor that specializes in this type of reaction, I would recommend a dermatologist. This is more a contact allergy or sensitivity, not a systemic allergy. So this is more in the area of dermatologists.

An autoimmune doctor is a rheumatologist. I am not sure if you need a rheumatologist, but you could always see your primary care doctor and ask him/her to test you for autoimmune issues. If those tests come back positive, your doctor could refer you to a rheumatologist.

But in my case, time was what I needed for my eyes and my eyelids to calm down.

[mcleary]

Thank you so much for this info. Did you have reactions to all eye drops? I'm waking up at night with bone dry eyes. I'm not sure if I can give the night time eye balm up. Did you have trouble with lotemax or restasis? I think my eye doctor wants to put me on Restasis next. My eyes do feel better when I take less eye drops. It's hard to turn my thinking around when my eye doctor was telling me to do more eye drops. Did you see a dermatologist? Did anyone prescribe anything that helped you get through this more easily? I wonder if I should go back to the allegra or oral steroids to help this.

[Scout]

Thank you so much for this info. Did you have reactions to all eye drops?

No, I did find one that I could tolerate. It was sold in Rebecca’s dry eye shop but is no longer manufactured. Everyone is different and you may find drops that you can tolerate well.

I'm waking up at night with bone dry eyes. I'm not sure if I can give the night time eye balm up.

Try doing cold compresses before bedtime. Sometimes that will shrink the inflammation prior to sleeping. Don’t give up what you know is working. Just try to be sure that you are not reacting later to the chemicals in the drops you are using overnight. But you don’t have to give up EVERYTHING. Just pay attention to what happens to your eyes after you use the drops.

Did you have trouble with lotemax or restasis? I think my eye doctor wants to put me on Restasis next.

My story is complicated by LASIK surgery years ago. In fact, so many years ago that when I asked my doctor for Restasis, he told me that it “was not approved for your type of dry eye.” Well now, years later, it is approved for EVERY TYPE OF DRY EYE!

Many people are helped by Restasis, but keep in mind that a small percentage of people are allergic or hypersensitive to the castor oil that is used in the drops. Some members here have the cyclosporine compounded with other types of oils that are more easily tolerated.

My eyes do feel better when I take less eye drops. It's hard to turn my thinking around when my eye doctor was telling me to do more eye drops.

Very true.

Did you see a dermatologist?

I saw a dermatologist when I had eyelid dermatitis but not when I had the hives. There are several members here that have posted about their testing for contact allergies and hypersensitivities by dermatologists. I did not have that done. The testing uses a patch on your skin with substances in the environment, which is different than typical allergy testing (scratch or injection on your arm or back with typical allergens).

I did most of my “research” by my own trial and error. I found out that I am highly reactive to fragrances, ESPECIALLY the “natural” ones like botanicals and citrus. I had to change most of my hair, skin and soap products.

When I had the hives, I saw my primary care doctor and was prescribed prednisone orally. I am pretty sure the allergic reaction was to a laundry detergent I used (Tide) on my bed sheets.

This is an old thread that I posted years ago. I like it a lot because so many people posted about their own allergies and sensitivities throughout the thread.

http://www.dryeyezone.com/talk/showt...act-Dermatitis

Did anyone prescribe anything that helped you get through this more easily? I wonder if I should go back to the allegra or oral steroids to help this.

Yes and no. My optometrist prescribed Zaditor, a prescription allergy drop that helped me very much. The problem was, it only helped when I was taking it. If I stopped, the symptoms worsened. I woke up one day and realized that I had taken it everyday for THREE YEARS. This was about the time that all the research on the damage that benzalkonium chloride (BAK) can do to the ocular surface was published. Yikes. So the medication that helped my symptoms initially, eventually made things worse. So I stopped that and started over again.

Cold compresses help. Removing substances around me that I am sensitive to help.

I have been good for several years now. I only stick around here and pop in occasionally when I think my experience could be helpful to someone else. I am grateful to many people who have posted on this forum over the years, many of whom have been helpful to me.

[mcleary]

Would you say that an allergist would be able to tell what I'm sensitive to (if that's the problem) or a dermatologist?

Thanks,
Michele

[Scout]

http://allergies.about.com/od/contac...tchtesting.htm

What Is Patch Testing?

Patch testing is used to identify causes of contact dermatitis. Contact dermatitis is an immunologic reaction to a particular substance; poison-oak (and poison-ivy and poison-sumac) is an example of such a reaction. Contact dermatitis is not a true allergy; therefore patch testing is performed in a very different way than allergy skin testing. There are no allergic antibodies involved in contact dermatitis; rather, various white blood cells entering into the skin cause the reaction.

How Is Patch Testing Performed?

Patch testing involves the placement of various chemicals onto the skin, usually held against the skin using a paper tape. The chemicals themselves are often contained within a small metal cup, usually smaller than a dime. Unlike allergy skin testing, patch testing does not involve the use of needles. Patch testing is available commercially in the United States as the T.R.U.E. test; some allergists and dermatologists order special chemicals from Europe or Canada to make up their own patch test panels (this is commonly done and is typically considered to be safe if the physician is trained in the performance of patch testing).

The tape (with attached chemicals contained within the metal cups) is applied to clean skin on the person’s back. The patch test remains on the skin for 48 hours. During this time, the person cannot get the tape wet; therefore, only a sponge bath can be taken, and excessive sweating should be avoided.
The patch test is removed by medical personnel after 48 hours (2 days), and an initial reading of the test is performed.

Since contact dermatitis involves the immune system, patch testing may result in a memory response. This means that the immune system “remembers” where it encountered a chemical to which the skin reacted. The original area of skin that reacted to a particular chemical could again get red and itchy after that same chemical was applied using patch testing, even though the patch test was placed on a different area of skin! For example, a person with contact dermatitis of the eyelids from cosmetics may notice that the rash on their eyelids gets worse after the chemical from the cosmetics was placed into a patch test on the person’s back.

Dermatologists have been performing these tests for years here in the US, not allergists, but there may be some allergists who also perform patch testing for contact allergies and sensitivities. I’ve only heard of dermatologists who do this type of test, though.

[unicorn]

Scout, I have recently been reading a lot of your posts and I must say they are all extremely interesting and helpful.

I have a question regarding contact allergies and patch testing you may be able to help with - if you don't seem to suffer from obvious skin problems (dermatitis), would it still be worth looking into patch testing to find out if there is a source for eye irritation?

I ask because my eye problems seem to have been triggered by an allergy to my contact lens solution, but now it seems my eyes are sensitive to so many more substances. For example I had a bad reaction to steroid drops that contained BAK, and a lot of other eye drops irritate. I also can't seem to tolerate eye makeup any more - it makes my eyes sting and water. Do you think patch testing may be helpful in identifying specific chemicals that I am sensitive to? Or is it just because my eyes have become more dry that they are super-sensitive?

I don't think I have eyelid dermatitis although the skin just around my lashes on my upper eyelids is very slightly bumpy and reddish. It had also been stinging slightly when wearing makeup for several months prior to my actual eyes becoming sore and red.

The only other symptom I have that may be indicative of some kind of allergy is rhinitis, which is perennial, and I have had it for years. I have had blood tests for allergies to grass, pollen, dust mites etc which came back negative. Oh, and I have rosacea - mild on my face - no-one will tell me for sure if I have ocular rosacea.

Sorry to jump in on this thread but I could really use some advice on this!

[littlemermaid]

Is there such a thing as an autoimmune doctor?

Sorry to jump in on this thread but I could really use some advice on this

Yes, please I'm finding the best current summaries are on Medscape, eg hypersensitivity. Otherwise immunology and eg Journal of Hormone, Lipid and Steroid Metabolism, I'm struggling. Yes, it would be nice to have a doc. There are ocular immunologists now, usually looking at uveitis http://www.uveitis.org/patients/list...r-immunologist but in UK this would be consultation money wasted for us currently because it's a different inflammatory/allergic pathway and we're trying to identify causes, aren't we.

[Scout]

I have a question regarding contact allergies and patch testing you may be able to help with - if you don't seem to suffer from obvious skin problems (dermatitis), would it still be worth looking into patch testing to find out if there is a source for eye irritation?

I ask because my eye problems seem to have been triggered by an allergy to my contact lens solution, but now it seems my eyes are sensitive to so many more substances. For example I had a bad reaction to steroid drops that contained BAK, and a lot of other eye drops irritate. I also can't seem to tolerate eye makeup any more - it makes my eyes sting and water. Do you think patch testing may be helpful in identifying specific chemicals that I am sensitive to? Or is it just because my eyes have become more dry that they are super-sensitive?

From my understanding, you do have dermatitis. It may be in the form of irritant or allergic dermatitis and it may be mild or moderate, but inflammation of the skin is the definition of dermatitis. There are many different forms, but it is an inflammatory reaction. A “reaction” is an inflammatory response to an irritant.

You are also describing the “cumulative” effect of allergic and inflammatory reactions: once your body reacts, it is prone to more reactions to substances that may not have caused reactions in the past.

I do think that dry eyes, or more likely poor tear breakup time can be caused by inflammation and also be a factor in causing further inflammation. Once inflamed, the surface is more sensitive and reactive to other substances. Plus it seems that a good tear film can protect the ocular surface and most likely "wash away" chemicals, etc. from the surface.

I often use the example of a bad sunburn. If you skin is inflamed by a bad sunburn, everything that touches your skin will hurt. Even water from your shower will hurt when it hits your skin. Lotions will sting when you apply them. Your skin is inflamed so it is much more sensitive.

I don't think I have eyelid dermatitis although the skin just around my lashes on my upper eyelids is very slightly bumpy and reddish. It had also been stinging slightly when wearing makeup for several months prior to my actual eyes becoming sore and red.

You just described eyelid dermatitis--an inflammatory reaction on the surface of your skin.

The only other symptom I have that may be indicative of some kind of allergy is rhinitis, which is perennial, and I have had it for years. I have had blood tests for allergies to grass, pollen, dust mites etc which came back negative. Oh, and I have rosacea - mild on my face - no-one will tell me for sure if I have ocular rosacea.

Again, rhinitis is an allergy, a systemic bodily reaction to allergens in the environment. Dermatitis is a form of inflammation caused by something that comes “in contact” with the surface of the skin or the surface of the eyes (this can include fragrances, which are airborne chemicals).

*********edit********* Oops, correction. Rhinitis can also be a form of contact inflammation. I had allergy testing years ago and nothing came up significant as an allergen. Then the allergist looked inside my nose and he did identify inflammation. He told me that the inflammation was caused by contact with allergens or irritants that would not show up on traditional allergy tests. Sorry, that was so long ago I forgot about it.********/edit********

Allergies and contact dermatitis are not the same thing, although they do often overlap.

I have never done the patch testing. I did my own research by changing and eliminating things around my environment. Several members have done the patch testing, with typical substances and some have had testing done with their own products. Maybe you can do a search for patch testing or T.R.U.E testing to get more information.

I hope this helps. I do not claim to be an expert, but I do have experience that I hope helps a few people.

[unicorn]

Thank you very much, Scout - this is really helping me in understanding where my eyes are at. It seems I am caught in a bit of an 'inflammatory cycle' - the dryness (short TBUT) is causing some inflammation and also I think exposure to various chemicals may be adding to the problem.

I can't use steroids (I am a steroid responder) so it's hard to break out of this cycle, even with trying to figure out what's contributing to the problem. Cold compresses help temporarily.

I think you're right about the eyelid dermatitis. I guess I hadn't recognised it as such because it's not very obvious - you have to look very closely to see the tiny bumps. I guess I thought the slightly swollen, reddish appearance was due to ocular rosacea (it still may be). My eyelids have not often had the stinging, sore feeling since I stopped wearing makeup but my eyes are still getting inflamed.

Regarding the rhinitis, it's complex because there is a condition 'non-allergic rhinitis' (which is what I've been told I have) that won't respond to typical allergy treatments but can often be triggered by some of the same substances eg strong fragrances, pollen etc. It is more of an irritant rather than allergic reaction, as I understand it.

It has occurred to me that now I'm not wearing contacts my eyes are more exposed to similar 'irritants' and may be reacting in a similar way.

As for patch testing, it is probably not going to be worth it, although I'll still bear it in mind. For now it may be a long hard process of eliminating as many chemicals/irritants as possible from my environment and seeing how I get on.

Thanks again.

[mcleary]

Scout,
My eye doctor said that he didn't see any signs of allergy in my eye. But my eyes felt bad. But, when I stop using all of my eye cream, makeup, toner, sunscreen, shampoo, conditioner, and hair moose, and started using a couple of things that didn't have ingredients in the possible allergen lists, my eyes feel a lot better. Plus I am only using preservative free eye drops. I have been able to avoid using drops until mid to late afternoon instead of using throughout the day. Plus I've been taking fish oil, omega-9 and vitamin c powder. I've been doing warm compresses morning and night, followed by cold compresses. If my eyes eventually don't require drops or anything anymore, do you think I should start using all of the products I stopped using again? How did it work with you?

Thanks,
Michele

[Scout]

Hi Michele,

My eye doctor said that he didn't see any signs of allergy in my eye. But my eyes felt bad.

Yeah, that seems like a common story. The eye doctor looks for signs of typical allergic symptoms and doesn’t seem to be aware of hypersensitivity reactions of the ocular surface. The symptoms of hypersensitivities seem to mimic “dry eye” or other forms of ocular surface inflammation, so they treat the symptoms with medications and drops only. It is definitely frustrating.

But, when I stop using all of my eye cream, makeup, toner, sunscreen, shampoo, conditioner, and hair moose, and started using a couple of things that didn't have ingredients in the possible allergen lists, my eyes feel a lot better. Plus I am only using preservative free eye drops. I have been able to avoid using drops until mid to late afternoon instead of using throughout the day.

Wow, this is really good news! I am really happy for you. What an improvement.

Plus I've been taking fish oil, omega-9 and vitamin c powder. I've been doing warm compresses morning and night, followed by cold compresses. If my eyes eventually don't require drops or anything anymore, do you think I should start using all of the products I stopped using again? How did it work with you?

Everyone is different, but in my case, I did my own experimentation. Here are some of the things I did and some of the things I learned.

I removed everything I could think of (within reason . . . you can’t stop washing your hair or face, etc., but I did change shampoos several times to the one I am currently using, Dove (another cheap brand).

I started slowly (after stopping most of my products and cosmetics) and added one or two things back at a time. Because hypersensitivities (as opposed to allergies and irritants) tend to have delayed reactions, you need to wait 3-4 days to see if you get an increase in your symptoms.

I already knew that many hair care products and facial products that contained citrus and botanicals were bad for me. I once had a facial and when the esthetician put a mask on my face I asked “Is this supposed to burn my face and eye?” She quickly removed it and after the second mask that burned like heck, she decided she would try her “pharmaceutical” line. It was fine! That is when I learned that “natural” or botanical products are worse for me than a mix of chemicals! LOL

In my experimentation with my products, I found that one of the cheapest brands (Tresemme) gave me the least problems. I now use the hair spray and mousse from that brand. When I get a haircut and style, I have to remind my stylist not to use her products, because everything she has used in her salon hurts my eyes. I almost told her to go over to Target to get some cheap stuff with chemicals for me, but I decided just to avoid all hair care products at her salon.

My experience and the brands that work and don’t work for me will probably not give you a clue about your own sensitivities. Everyone is different and everyone is sensitive to different products.

As for makeup, I added foundation first (thank goodness!) and found that the Clinque brand foundation was fine. I added the pressed powder and that was fine. But at NO TIME was I able to wear any eye makeup. I didn’t try that many brands because I finally gave up on it. I still mourn the use of mascara. But comfortable eyes won out.

One of the products that was the WORST for me was my scented body lotion from Clinique (Happy). I love that scent, but it was toxic for me. I now use another cheap brand that I pick up at Target.

I have always had problems with sunscreen and just when I find one that works, they change the formula to the “new and improved” version. I used Nutragena Sensitive Skin for years until they “improved” it and I had a rash on my skin and painful eyes for days. Sigh.

I now use a Target brand sunscreen (until they “improve” that formula).

I could go on and on. But your experimentation will be unique to you. I do think you will be able to use some cosmetics and even some of the products you currently use, but experiment first and add one or two at a time, to make sure an offending product isn’t added back into your daily routine.

Just remember, cosmetics manufacturers don’t have to tell the truth about what is in their products so don’t rely just on the labeling. There is a clause in the government regulation that allows the companies to keep their “secret formulas” secret. So they have been known to keep some ingredients off their labels.

Good luck. And I am really glad you are making improvements.

I hope this helps.

Scout

[spmcc]

I am currently using, Dove (another cheap brand).

In my experimentation with my products, I found that one of the cheapest brands (Tresemme) gave me the least problems.

One of the products that was the WORST for me was my scented body lotion from Clinique (Happy). I love that scent, but it was toxic for me. I now use another cheap brand that I pick up at Target.

You've mentioned a couple of times that the least expensive products were the best (least harmful) for you. I am the same way. And I remember a program that compared "cheap" shampoos with the expensive/salon brands. The guy explained that the expensive/salon brands contain more perfumes/scents and that was basically the thing that separated them from the "cheap" stuff. For my skin and eyes (and lungs), I find that staying away from perfumes/scents is a must... and that could be one reason why the "cheap" brands are best for me.

[mcleary]

Have you had any luck with eye liners or cover-up? What brands/name? I look terrible without eye makeup. I tried this mascara I got from Lori's Natural Foods in my town, but it's not doing much for me. I think it's just coating my lashes with vitamin/oil with coloring in it.

[alittlemotel]

Are you still on the Allegra? That can cause dry eye.