Younger Age is Linked to Eyewash Use in Allergic Rhinitis

A cross-sectional cohort study identified factors linked to eyewash use in individuals with allergic rhinitis, such as younger age, previous psychiatric illness, and contact lens use, among others.1 The study also found dry eye symptoms were linked to both eyewash and non-eyewash use.

“This suggests that older patients and those with hay fever and concomitant [dry eye] disease who do not routinely use eyewash—despite evidence of a reduction in early-phase ocular symptoms and its safety profile—may represent vulnerable populations that could benefit from public health initiatives aimed at promoting and raising awareness of better self-care for hay fever,” wrote investigators, led by Takenori Inomata, MD, PhD, from the department of ophthalmology at Juntendo University Graduate School of Medicine in Japan.

Patients with allergic rhinitis-related ocular symptoms may turn to eye wash for symptom relief. Readily available over the counter, eyewash is a common way people manage these symptoms, eliminating ocular surface allergens, eosinophils, and allergic mediators from the eyelid margin.

However, frequent eyewash may be harmful, potentially disrupting the physiological tear film homeostasis and leading to dry eye disease. Preservatives such as bezalkonium chloride, often an ingredient in commercial eyewash products, may worsen allergic symptoms if overused.2

Limited epidemiological data exists on eyewash users with allergic rhinitis. Inomata and colleagues conducted a digital cross-sectional cohort study between February 2018 and May 2020 to pinpoint eyewash usage and preferences in individuals with allergic rhinitis from Japan.1 Using AllerSearch, a smartphone application that collects data on demographics, medical history, lifestyle, allergic rhinitis symptoms, current and past treatments, and preventive measures, investigators assessed factors associated with eyewash and non-eyewash users with allergic rhinitis.

Among the 9041 participants with allergic rhinitis, 40.7% were eyewash users. Eyewash users either used eyewash products as needed during symptom flare-ups (43.9%), in the morning (24.8%), and in the evening (19.4%). Additionally, eyewash users had significantly greater total nasal symptom scores, total non-nasal symptom scores, and total symptom scores (P < .001) than non-eyewash users.

A multivariable logistic regression analysis found younger patients < 20 years (47.6%) had a significantly greater usage of eyewash products than patients aged 20 – 30 years (41.5%) and aged 40 – 50 years (40.3%).

“This likely reflects the higher sensitivity and awareness of new medical information among younger generations, allowing for faster adoption of eye washing as part of their symptom care routine,” investigators wrote. “This underscores the importance of educating older populations about the demonstrated efficacy of available new hay fever management tools, including eye washing.”

Aside from younger age, eyewash use was also linked to previous psychiatric illness, history of contact lens, current contact lens use, active smoking, higher yogurt intake, lower nasal symptom score, greater non-nasal symptom score, and dry eye symptoms. Moreover, non-eyewash use was associated with older age, sleep duration < 6 hours, lower yogurt intake, and dry eye symptoms.

Investigators wrote the findings may have been limited by the study using a smartphone application, which may have prevented some older adults to participate who did not have a smartphone device, specifically an iPhone. Also, many participants lived in an urban setting. They noted findings also could have been impacted by visual fatigue; participants may have quickly filled out the survey to finish it.

“…rather than indicating a causative effect of eyewash on [dry eye], our results likely reflect that patients with more severe ocular symptoms, including both allergic conjunctivitis and [dry eye], use eyewash as an effective self-care measure for both disease processes,” investigators wrote. “However, more severe DE has been observed among eyewash users with ocular symptoms, suggesting concerns about exacerbating [dry eye] with frequent eyewash use.”

References

1. Inomata T, Sung J, Nagino K, Midorikawa-Inomata A, Eguchi A, Adachi T, Kobayashi H, Nakao S. Profiling eyewash usage and preferences in individuals with hay fever using a digital cross-sectional cohort study with AllerSearch. Sci Rep. 2025 Mar 10;15(1):8275. doi: 10.1038/s41598-025-93027-z. PMID: 40065121.

2. Yazu H, Kozuki N, Dogru M, Shibasaki A, Fujishima H. The Effect of Long-Term Use of an Eyewash Solution on the Ocular Surface Mucin Layer. Int J Mol Sci. 2019 Oct 13;20(20):5078. doi: 10.3390/ijms20205078. PMID: 31614909; PMCID: PMC6834188.