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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 10608
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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I would like to some advice on eye allergies. I wake up every

Resolved Question:

I would like to some advice on eye allergies. I wake up every morning with extremely watery, red rimmed eyes and post nasal drip. My eyes constatnly bother me throuhout the day and I constantly deal with post nasal drip. I saw a local opthamologist and he determined my eyes were dry via the schirmer test and put in punctal plugs. After which, my eyes felt much better in the morning but throughout the day, they continue to get irritatedl, and I can't remember the last time I didn't deal with post nasal drip. I explained this to my opthamologist and he put me on Bepreva which provided little help so I'm not sure which way to turn. I started thinking that allergies may have been my problem from the start. There are times when my eyes get extrememly bad and I have to resort to about 7-10 days of Alrex to clear them up, but I can't figure out what the trigger is. The episodes don't coincide with seasonal changes or any readily apparent source so I'm a little frustrated. After my Alrex course, my eyes will be fine for 3-4 weeks but then, without fail, it happens again, and back to the Alrex. I'm looking for some sort of advice because I always get treated for the episode but I can't find the root cause of this misery. Could I be dealing with dry eye or doe sthis sound more like allergies.

48 years old
meds: daily allergy tab, multi-vitamin, fish oil.
Submitted: 4 years ago.
Category: Eye
Expert:  Dr. Rick replied 4 years ago.

Dr. Rick :

Hi. I'm online and happy to answer your question today.

Dr. Rick :

Hi Donald. From what you have told me I do believe that allergies are one component of your problem. You already noted some improvement after your dry eyes were addressed. The one thing that I believe you are missing is treatment for blepharitis. Many times, in my experience, all three of these conditions are at play at the same time.

Dr. Rick :

When it comes to allergies it is almost impossible to pin down the offending agent(s) and, therefore, treatment needs to focus on controlling the symptoms. Dry eyes are very common and can be improved by a stepwise series of therapies. First, the use of natural tears 4-6+ times/day to augment your natural tear production, if this doesn’t work then you can try temporary punctal occlusion of the lower puncta, then, if needed, temporary occlusion of all 4 puncta then, if indicated, surgical ( non-reversible) closure of the puncta. The openings to your tear drainage system are called puncta and you have one opening on each lid, near your nose.


Blepharitis is a condition where glands in the eyelids are not functioning normally. They become plugged and instead of putting out their normal clear, oily secretions, they put out thick, toothpaste like gunk. You may not be able to see this “gunk” yourself, unless it is really bad, but it shows up clearly on slit lamp examination.


The best treatment for this condition daily lid scrubs combined with warm compresses. I like to use baby shampoo for lid scrubs. In the shower, place the shampoo on your index fingers, close your eyes, raise your eyebrows (to stretch the skin on your eyelids) and scrub back and forth along your eyelashes for 3 to 5 minutes. The hot water in the shower helps to soften the plugged oils in the glands while the mechanical scrubbing with your soapy fingers removes the oils.


Baby shampoo lid scrubs will also help to wash away allergens and stimulate tear production, thereby addressing all three of your issues. Remember, this is not an instant fix. While you are waiting for the lid scrubs to have affect you can use over the counter allergy pills such as Travist, dimetapp or Zyrtec.


Should your symptoms get worse, your vision become significantly affected or things just not get better in 3 weeks or so you should have a complete eye examination by your local ophthalmologist to look for other, less common, causes of your symptoms.



Dr. Rick :

Since you have already spent time with your ophthalmologist on this issue I would give the above treatment a month to see how it works. If things are not resolved, or at least much better, by then I would make an appointment with an allergist for the million dollar workup.....

Dr. Rick :

Does this make sense to you?


My original appointment my doctor put me on a med (can't remmeber the name) for Bleph but at my follow up, he noted no problems but yet my eyes still feel lousy. I do lid scrubs and I find that flushing my eyes with eye wash helps but only for a short time.

Dr. Rick :

do you do the scrubs like I outlined above? Also, try not to rinse your eyes out with tap water as it can contain nasty bugs that can cause a very, very difficult form of corneal ulcer to treat. Use sterile saline, such as that used by contact lens users.

Dr. Rick :

was the med doxycycline?

Dr. Rick :

Still there?

Dr. Rick :

I'm not sure if you are still at your computer. If you have not been evaluated by a corneal specialist already, and you feel that you have already tried everything I've outlined above without improvement, then I would suggest an complete exam by a corneal doc as well as an allergy specialist.

Dr. Rick :

I guess you are no longer at your computer.

Dr. Rick :

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Expert:  Dr. Rick replied 4 years ago.
Let me know if there are there any other concerns or issues you would like to discuss on this topic.
Customer: replied 4 years ago.

Sorry Doc, I had to grab the phone. I just remembered the drug was called Azasite. Could allergies cause Bleph? Could I have Bleph without the crusting around the eyelashes? My eye problems do resemble the Bleph symptoms. One last question, why does the Alrex course seem to make me feel better for several weeks at a time? I will try the lid scrubs as you indicated.



Expert:  Dr. Rick replied 4 years ago.
No the allergies would not be expected to cause blepharitis but I have found that co-exists in patients with dry eyes and allergies. It is so easy and inexpensive to treat that I recommend getting rid of it to see if you feel better.

Alrex is a steroid and makes all eye irritations feel better. It only addresses the symptoms and not the discomfort so, when you stop using it, or after you use if for too long and it becomes less effective, your symptoms come back. It is a lot like putting a bandaid on a machine gun wound.....

I am happy to be able to help you today. If you would be so kind, please help me get credit for my efforts in answering your questions and press the ACCEPT button for this encounter. I would also be happy to continue to answer any more questions you have until we have resolved your concern.
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