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The tear breakup time over the contact lens surface differed between lens types and may have a role in protecting the ocular surface.

Objective: To investigate whether artificial tears and cold compress alone or in combination provide a treatment benefit, whether they were as effective as, or could enhance topical anti-allergic medication. Design: Randomized masked clinical trial. Participants: Eighteen subjects (aged 29.5 ± 11.0 years) allergic to grass pollen Intervention: Controlled exposure to grass pollen using an environmental chamber to stimulate an ocular allergic reaction followed by artificial tears (AT), 5 minutes of cold compress (CC), AT combined with CC, or no treatment applied at each separate visit in random order. A subset of 11 subjects also had epinastine (EH) applied alone and combined with CC in random order or instillation of a volume matched saline control. Main Outcome Measures: bulbar conjunctival hyperemia, ocular surface temperature, ocular symptoms repeated before and every 10 minutes after treatment for 1 hour Results: Bulbar conjunctival hyperemia and ocular symptoms decreased and temperature recovered to baseline faster with non-pharmaceutical treatments compared to no treatment (p < 0.05). AT combined with CC reduced hyperemia more than other treatments (p < 0.05). The treatment effect of EH was enhanced by combining it with a CC (p < 0.001). CC combined with AT or EH lowered the antigen-raised ocular surface temperature below the pre-exposure baseline. AT instillation alone or CC combined with AT or EH significantly reduced the temperature (p < 0.05). CC combined with AT or EH had a similar cooling effect (p > 0.05). At all measurement time intervals, symptoms were reduced for both EH and EH combined with CC than CC or AT alone or in combination (p < 0.014). Conclusions: In a controlled exposure to grass pollen, cold compresses and artificial tears showed therapeutic effect on the signs and symptoms of allergic conjunctivitis. A cold compress enhanced the use of epinastine alone and was the only treatment to reduce symptoms to baseline within an hour of antigenic challenge. Signs of allergic conjunctivitis were generally reduced most by a combination of a cold compress in combination with artificial tears or epinastine. Ref 2013-759R1 Effectiveness of Non-Pharmacological Treatments for Acute Seasonal Allergic ConjunctivitisDear Prof. Bartley, RESPONSES IN CAPITALSThank you for submitting a revised version of the above-referenced manuscript. We would like to accept it for publication as soon as a few final issues have been satisfactorily addressed, as listed below: WE ARE DELIGHTED Thank you for revising your manuscript. In reviewing your revisions, I have only a couple of comments. First, as regards the suggestion of Reviewer 2: P 7, LM 170 and multiple places elsewhere (including P 8, LM 193; P 8, LM 201): When comparing 2 variables, use the term "between;" when comparing 3 or more variables, use the term "among."I suspect that what the reviewer was trying to point out is that Strunk and White, in "The Elements of Style", recommend the following as regards the use of "among" and "between": "When mor...