cloudy sky at dusk with smoke

The Impact of Air Quality on Vision


Symptoms of wildfire smoke exposure can mimic allergies

In early August, Denver, Colorado, was listed as the most polluted city in the world by the website, which tracks air quality for major cities. Salt Lake City, Utah, was also in the top five for worst air quality. The smoke from the Dixie Fire in California was to blame for the poor air quality across the West. In July, wildfire smoke from Canada and Oregon spread across the country, causing unhealthy air quality as far away as New York and Pennsylvania. 

As if the ongoing COVID-19 pandemic wasn’t bad enough, “exposure to air pollutants in wildfire smoke can irritate the lungs, cause inflammation, alter immune function, and increase susceptibility to respiratory infections, likely including COVID-19,” according to the CDC. Wildfire smoke can also irritate the eyes, impacting vision. 

Here are some suggestions for how to talk to your patients about this issue. 

Smoke’s harmful effects on eyes

Wildfire smoke is made up of a complex mixture of air pollutants that are harmful to human health, including the lungs and eyes. An observational study published in January in the British Journal of Ophthalmology found that poor air quality could significantly increase the odds of developing age-related macular degeneration (AMD). AMD is a leading cause of vision loss and irreversible blindness in Americans age 60 years and older. 

A study found that poor air quality could significantly increase the odds of developing age-related macular degeneration.

Although environmental factors may be linked to AMD, age is still the biggest risk factor for the disease. Because the effects of air pollution are difficult to isolate and to avoid, the message to patients should be that maintaining a healthy lifestyle is the most effective prevention. Encourage patients to stop smoking, eat a well-balanced diet, maintain a healthy weight, and manage high blood pressure and heart disease risk factors.

Air pollution caused by wildfires can also cause stinging, watery, or blurry eyes. Tell patients the best way to avoid smoke irritation is to avoid exposure as much as possible by staying inside. However, over-the-counter eye drops can help relieve irritation and blurriness caused by smoke exposure. 

Confusion with seasonal allergies

Patients may be confused as to whether their eye symptoms are caused by wildfire smoke exposure or seasonal allergies. It’s important to know, since treatment varies and won’t provide relief if you’re treating the wrong thing. 

While the symptoms of fall allergies and smoke exposure can be similar, there are some differences–and they need to be treated differently.

While the symptoms of fall allergies can be similar to symptoms from smoke exposure, such as persistent runny nose, sneezing, and itchy or watery eyes, compared to seasonal allergies, “smoke exposure can be more temporary and include more burning than itching, which typically comes with allergies,” Dr. Tina Sindher, allergist at Stanford Health Care, told Healthline.

Encourage patients to come into your practice for a comprehensive exam so you can properly diagnose them and tailor a treatment plan for them. If their symptoms are caused by allergies, patients may not be aware that there are newer treatment options available now besides the long-used sedating antihistamines like Benadryl and Chlor-Trimeton. 

Tell your patients that for moderate to severe seasonal allergies doctors now prefer nasal steroids, such as Flonase and Nasacort sprayed directly into the nose and used daily, for over-the-counter allergy treatment. Advise patients to stick with them for a couple of weeks, since they can take time to work. If patients prefer a pill to a nasal spray, let them know that the “second-generation antihistamines,” such as Allegra, Claritin, and Zyrtec are an option.

For more information about encouraging patients to come into your eye care or ENT practice for help with allergies, read our post Prepare Patients for Allergy Season


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