Ocular Allergies
Ana MacDowell, MD
Allergy Partners of Fayetteville, North Carolina

If your eyes become itchy, watery, and red this time of year, you may have an eye allergy. Also called allergic conjunctivitis, it occurs along with allergic rhinitis (hay fever) in almost half the cases. Allergic conjunctivitis is very common, affecting over 20 million Americans. It is important to be diagnosed correctly and to rule out conditions that are not related to allergy so the appropriate treatment can be started.

Allergy Responses of the eye

Allergic conjunctivitus may cause lid swellingAllergic conjunctivitis is triggered by hypersensitivity to an allergen involving allergic antibody, or IgE. Symptoms may include eye itching, lid swelling, watery discharge, and redness of the conjunctiva (white portion of the eye). It can occur in a variety of circumstances. Seasonal allergic conjunctivitis results from allergies to the pollen of trees (early spring), grasses (late spring), and weeds (fall). This is by far the most common, representing 80% of all cases.

Perennial allergic conjunctivitis is similar to the seasonal although is usually milder and lasts all year; related to allergens from animals, mold spores and dust mite. Seasonal worsening of symptoms can occur in the same person causing “double trouble”.

Vernal keratoconjunctivitis is a sight-threatening disease seen in children younger than 14 years of age and affects boys twice as often as girls. It is more common in the Spring and Fall in dry, warm climates. Common symptoms, include inner lid discomfort, and severe light sensitivity (photophobia). Excessive tearing, with thick, stringy discharge, a sensation of a foreign body and cobblestone appearance of the inner portion of the eyelids all can be observed.

Non-allergic conditions

Giant papillary conjunctivitis is the result of eye contact with foreign surfacesGiant papillary conjunctivitis is the result of eye contact with foreign surfaces, often contact lenses. It is usually combined with an allergic component. Symptoms include decreased tolerance to contact lenses, blurred vision, itching, sandpaper feeling and increased mucus secretion.

Atopic keratoconjunctivitis often occurs in patients with eczema. It is associated with severe eye itching and burning, photophobia, fissuring of the eyelid, and corneal damage. Cataracts, and even blindness, can occur as an outcome of this disease or its treatment.

Top

Other Nonallergic Conjunctivitis

Infectious conjunctivitis (pink eye) is caused by bacterial or viral infectionInfectious conjunctivitis (pink eye) caused by bacterial or viral infection may affect one or both eyes. A dry eye syndrome (keratoconjunctivitis sicca) characterized by decreased tear production, may lead to red, irritated eyes. In addition, infection of eyelids (blepharitis) and overuse of eye drops may lead to a prolonged inflammatory response often mistaken for allergies.

Treatment of Ocular Allergies

Avoidance is the mainstream treatment, so for this reason identifying causative allergens is very important. A careful history combined with skin testing determines responsible allergens, providing important information toward removal of the offending agents. Appropriate medication will stabilize the process and prevent recurrent problems.

Avoidance strategies:

  1. Hand washing is extremely important, preventing contamination with allergensHand washing is extremely important, preventing contamination with allergens.
  2. Keeping windows closed at home and car lessens pollen exposure
  3. Filters minimize home contamination.
  4. Mowing the lawn with eye goggles decreases pollen exposure
  5. Pets bring allergens into the home, therefore paws and fur should be cleaned upon entry
  6. Special mattress and pillows covers aid in dust mites avoidance.

Treatment Options

  • Diluting allergen with artificial tears may be effective. Over-the-counter (OTC)
    preparations should be used with caution since they contain preservatives, which may exacerbate symptoms.
  • Some OTC medications provide temporary relief; however, many irritate the sensitive
    eye.
  • Cromolyn is well tolerated and can be a useful preventative measure.
  • Local decongestants promote blood vessels constriction, reducing redness, although
    may lead to complications like glaucoma and rebound redness.
  • Local corticosteroids are effective but are reserved for difficult-to-control allergic conjunctivitis. Prolonged use may lead to cataracts and increased susceptibility to viral infections.

Other prescription medications either block histamine (azelastin, levocabastine), prevent its release (nedocromil, lodoxamide, pemirolast) or both (olopatadine, epinastine and ketotifen) or act as an anti-inflammatory agent (ketorolac). Often eye symptoms improve by optimizing treatment of allergic rhinitis, especially when intranasal steroids are part of treatment regimen. Oral, nonsedating antihistamine can lead to symptom relief as well.

Allergy shots (immunotherapy) may be initiated, helping achieve adequate control of not only the eye symptoms, but also often associated allergic conditions. There are many different manifestations of eye allergy, and many effective treatments. All therapy should be coordinated by a knowledgeable health care professional, since misdiagnosis or incorrect therapy can have substantial adverse effects.

An allergist, who is specialized in diagnosing and treating these conditions, can be the key to getting your allergic conjunctivitis, and all your allergy conditions, under the best control possible.

by Ana MacDowell, MD
Allergy Partners of Fayetteville, North Carolina

Allergy Partners, P.A. provides diagnostic testing and treatment of allergies, asthma and sinus diseases in a caring and professional environment, nation-wide at 22 office locations.

Click here to locate an Allergy Partners Office in your region.

Top