Best ways to help with itching

Allergies are very common this time of year. If your eye is itching, it is almost always due to an allergy, Demodex mites, bug bite, or new reaction to a chemical or a combination of these irritants. 

Check listen to our podcast & youtube videos as well:

https://podcasts.apple.com/us/podcast/the-eye-show/id1569268568?i=1000532420913

https://podcasts.apple.com/us/podcast/the-eye-show/id1569268568?i=1000649918683

https://youtu.be/qzo98Y5N7GY?si=eO_XVVDrlCdoxTg0

Below are some of the best ways to help with itching.

A. At the first signs of itching try the following in this order:

1. First: As soon as itching starts, apply a cool/cold compress over the area. (This will stabilize the mast cells that release histamine when you rub the eye or area that is itching which makes itching worse. You can use cold, clean water, cold towel, frozen peas, etc.)
2. Second: try using preservative free artificial tears (see notes on preservatives below).* They are also called Non-preserved artificial tears like Refresh Plus, Refesh MGD, Systane, Optase, Theratears.
3. Third: Try Avenova spray (It’s over-the-counter and patient can follow the instructions on the outside of the box & put in the refrigerator as cold helps with allergy & itching) and non-preserved artificial tears in the refrigerator.
4. Fourth: If this does not help, they can try over-the-counter anti-itch drops like Pataday or Alaway drops see below but most of them have preservatives which have long term risks: see below.*
5. Fifth:  If this does not help, we can call in a prescription, but that’s often not covered by insurance and is expensive. Zerviate (cetirizine ophthalmic solution) which is preservative free which we always preserve. Let. us  know if you want an Rx for this. 
6. Sixth: if nothing is helping we can call in a STEROID drops but almost all have a preservative and steroids use can increase your risk of cataract or glaucoma if used over weeks-months (depending on risk factors): if you use steroids 4x per day for 1-2 weeks, SEE YOUR EYEMD or EYEOD for an eye pressure check to be sure you do not have a genetic risk for high eye pressure after steroid use (ie to be sure you are not a “steroid responder”). Steroid drops can also increase your risk of infection and some people are very sensitive to the preservative in steroid drops. If you ever get worse with any drop, stop it and let us know.
7. Seventh: An excellent alternative to preservative drops is Platelet rich plasma (PRP) drops. PRP is made up of your own platelets which healing your cells, contain your own growth factors, and has no  preservatives. Listen to below for more information: https://podcasts.apple.com/us/podcast/the-eye-show/id1569268568?i=1000613696819

NOTES: 

*Preservatives in eye drops are known to damage the eye’s delicate cells:

See: https://www.blogger.com/u/2/blog/post/edit/preview/1301797728403492391/4203784363735762042

**Most Over the counter (OTC) drops used to treat allergic conjunctivitis or general eye allergies have preservatives. These include medications such as:

 1. Olopatadine (Patanol, Pataday): An antihistamine that reduces the natural chemical histamine in the body. 

2. Ketotifen (Zaditor): Another antihistamine that can also stabilize mast cells. 

3. Azelastine (Optivar): An antihistamine and mast cell stabilizer. 

4. Alcaftadine (Lastacaft):  A newer antihistamine with once-daily dosing. 

5. Epinastine (Elestat): An antihistamine with mast cell stabilizing properties. It's important to use these medications under the guidance of a healthcare professional, as they can help determine the most appropriate treatment for your specific condition.

We can call the below prescription drop into your pharmacy but it is often not covered by insurance. The only way to know if it is covered is to call your insurance or check with the pharmacist which is very frustrating for everyone: 

Zerviate (cetirizine ophthalmic solution). Let us know if you want an Rx for this. 

If none of these work, steroid drops are often used to help with itching but almost all of them have a preservative and can increase your risk of cataract or glaucoma if used over weeks-months (depending on risk factors). 

Platelet rich plasma (PRP): is a natural, Non preserved option which can help. 

https://podcasts.apple.com/us/podcast/the-eye-show/id1569268568?i=1000613696819

Preservative-free eye drops that combine both antihistamine and mast cell stabilizing properties are limited. 

However, here are some options that may be available in preservative-free formulations or single-use vials:

1. Ketotifen: Zaditor (some formulations may be preservative-free) 
2. Alaway (some formulations may be preservative-free) 
3. Olopatadine:  Pataday (some formulations may be preservative-free)
   
   Always check the packaging or consult with a pharmacist to ensure that the specific product you choose is preservative-free. If preservative-free formulations are not available in your region, single-use vials are often a preservative-free alternative.