By Thomas L. Johnson II, MD –
It has been said that the eyes are the windows to the soul because they reflect our state of mind. However, surely this isn’t true if our eyes are red, swollen, watery, and itchy from an allergic reaction. Severe allergic eye symptoms can be very distressing and are a common reason for visits to the allergist, ophthalmologist, and even the emergency room. Occasionally, severe eye allergies cause serious damage that may lead to blindness if not cared for properly.
Eye allergies are generally associated with other allergic conditions, particularly hay fever and dermatitis. The causes of eye allergies are similar to those of allergic asthma and hay fever. Medications and cosmetics can play a significant role in causing eye allergies. Reactions to eye irritants and other eye conditions (for example, infections such as pinkeye) are often confused with eye allergy. Any kind of irritant, whether environmental, infectious, or manmade, can cause symptoms consistent with eye allergies.
Developing allergy symptoms is much the same for the eyes as that for the nose. Allergens cause the allergy antibody IgE to coat numerous cells in the conjunctiva, the tissue lining (mucus membrane) that covers the white surface of the eyeball and the inner folds of the eyelids. Upon re-exposure to the allergen, histamine and other mediators are released. As a result, itching, burning, and runny eyes become red and irritated due to inflammation, which leads to congestion. The eyelids may even swell, sometimes to the point of closing altogether. In some cases, the conjunctiva swells with fluid and protrudes from the surface of the eye, resembling a “bubble” on the eye. These reactions can also induce light sensitivity. Typically, both eyes are affected by an allergic reaction. Occasionally, only one eye is involved, particularly when only one eye is rubbed with an allergen, as this causes mast cells to release more histamine.
What are symptoms and signs of eye allergies?
Typical symptoms associated with eye allergies include inflammation of the conjunctiva that is caused by a reaction to allergens. The inflammation causes enlargement of the blood vessels in the conjunctiva (congestion), resulting in a red or bloodshot appearance of the eyes. These symptoms can range from very mild redness to severe swelling associated with discharge.
The most common eye allergy is conjunctivitis, also called allergic rhinoconjunctivitis,. Conjunctivitis is usually seasonal and is associated with hay fever. The main cause is pollens, although indoor allergens such as dust mites, molds, and dander from household pets such as cats and dogs may affect the eyes year-round. Symtpoms include itching, redness, tearing, burning, watery discharge, and eyelid swelling.
The treatments of choice are topical antihistamine drops, decongestants, and medications. Topical steroids should be used only if prescribed by a doctor for severe reactions and on a short-term basis because of the potential for side effects. In general, oral antihistamines are the least effective option, but they are often used for treating allergic rhinitis together with allergic conjunctivitis.
Most people with eye allergies treat themselves and do so quite effectively with OTC products. Most commonly, home care consists of flushing the eye with water. With exposure to an allergen to the eye, it is important to thoroughly flush the eye with lukewarm tap water or commercially prepared eyewash solution. If these remedies are not working or if there is eye pain, extreme redness, or heavy discharge, you should seek medical advice. Some conditions, for example, are serious with potential sight-threatening complications if required treatment is delayed.
When avoidance of offending allergens and local treatments are not effective, allergy shots may be administered. Your allergist may suggest this form of treatment when other measures have proven to be unsuccessful at treating the symptoms.
Conditions that are often confused witheye allergies
The following is a list of conditions that often produce symptoms that are commonly confused with eye allergy.
Dry eye results from reduced tear production and is frequently confused with allergy. Common symptoms include burning, grittiness, or the sensation of “something in the eye.” Dry eye usually occurs in people over 65 years of age and can be worsened by oral antihistamines like Benadryl, Atarax, Claritin, or Zyrtec, sedatives, and beta-blocker medications.
Tear-duct obstruction is caused by a blockage in the tear passage that extends from the eyes to the nasal cavity. This condition is also typically seen in the elderly. The main complaint is watery eyes that do not itch. Allergy testing will be negative in this case.
Conjunctivitis due to infection is caused by either bacteria or viruses. In bacterial infections, the eyes often appear to be bright red and the eyelids stick together, especially in the morning. The eyes may also produce a discolored mucous discharge. Viral conjunctivitis causes slight redness of the eyes and a glassy appearance from tearing. Adenovirus is a major cause of viral conjunctivitis. Adenovirus infection is very contagious and may be spread by either direct contact, such as hand contact, or in contaminated swimming pools. You should seek medical attention if you suspect any of the above.
We see the world through our eyes, if bothered by allergy symptoms the picture we see may not be as bright and sunny as it truly is. If you are experiencing any of the symptoms mentioned above and you haven’t been able to manage them on your own it may be time to seek medical advice.
TIPS FOR IRRITATED EYES
. Do not rub your eyes! Rubbing itchy eyes is a natural response. However, rubbing usually worsens the allergic reaction due to the physical impact on the mast cells, which causes them to release more mediators of the immune response.
. If your eye itches and is red, it is most likely due to allergy.
. A burning sensation is probably dry eye.
. Moistening the eyes with artificial tears helps dilute allergens and also prevents the allergens from sticking to the conjunctiva. Tear substitutes may also improve the defense function of natural tears.
. Cold compresses may help, particularly with sudden allergic reactions and swollen eyes.
. Keep eye drops refrigerated since this makes application more soothing.
Allergy & Asthma Care of Florida