Eye Allergies

Up to 50 million Americans suffer from the miseries of allergies, with allergic reactions involving the eyes being a common complaint. An allergic reaction that affects the conjunctiva, a clear layer of skin overlying the eyes, is commonly referred to as allergic conjunctivitis.

Allergic conjunctivitis is divided into several major subtypes, but the most common subtypes are seasonal allergic conjunctivitis (SAC) and perennial allergic conjunctivitis (PAC). SAC and PAC are triggered by an immune reaction involving a sensitized individual and an allergen. Simply stated, this means that if you are allergic to a particular substance and then come into contact with it, you experience an allergic reaction (eg, itching, sneezing).

Although it frequently occurs, allergic conjunctivitis is most commonly seen in areas with high seasonal allergens.

Ocular (eye) allergies often affect the conjunctiva, a clear layer of skin overlying the eyes. This clear layer of skin is the same type of skin that lines the inside surface of the nose. Because these two areas are so similar, the same allergens (substances that induce an allergic reaction) can trigger the same allergic response in both areas.

Common allergens include:

• Pollen
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• Grass
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• Weeds
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• Dust
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• Pet dander

The main difference between SAC and PAC is the timing of the symptoms.

• If you have SAC, you generally have problems for a short period of time.
  
  
  • You may be bothered in the spring by tree pollen, in the summer by grass pollen, or in the fall by weed pollen.
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  • Generally, your symptoms resolve during other times of the year, especially in the winter.
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• If you have PAC, your problems probably last throughout the year.
  
  
  • Instead of outdoor allergens, you have problems with indoor allergens, such as dust mites, cockroaches, and pet dander.
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  • Seasonal outdoor allergens may worsen your problems if you are sensitive to them as well.

SAC and PAC have identical symptoms, only the timing of the symptoms is different.

• With SAC, your symptoms are generally limited to a particular season (ie, spring, summer, fall).
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• With PAC, your symptoms probably last all year.

Almost always, the symptom of itching indicates an allergic reaction. This is true of allergic conjunctivitis, where the primary symptom is ocular itching. In addition to ocular itching, you may experience the following symptoms:

• Redness
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• Tearing
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• Burning sensation
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• Blurred vision
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• Mattering and/or mucous production

If you suffer from allergies but can identify and avoid whatever you are allergic to, your allergies should improve markedly. If you are unable to identify or avoid the allergens, seeking care for your ocular allergies from an ophthalmologist (a medical doctor who specializes in eye care and surgery) may help to make them more bearable.

• If you have SAC, you may want to make an appointment with your ophthalmologist prior to the season in which you suffer from allergies in order to start treatment before your symptoms from ocular allergies begin.
  
  
• If you have PAC, routine appointments with your ophthalmologist may be helpful to monitor your ocular allergies. Occasional flare-ups of your symptoms may require more frequent visits. Consultation with an allergist may be very beneficial.

|Questions to Ask the Doctor|

• Is there a specific, identifiable cause?
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• How can I reduce my symptoms?

Frequently, your ophthalmologist is able to diagnose ocular allergies from your complaints alone. As part of the eye examination, your eyes are examined to help rule out other problems.

• The front of your eyes are examined using a special microscope, called a slit lamp. Using the slit lamp, your ophthalmologist checks your eyes for dilated blood vessels, conjunctival swelling, and eyelid swelling, all of which are indicative of an allergic reaction.
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• Rarely, scraping of the conjunctiva is performed to check for eosinophils. Eosinophils are certain cells that are commonly associated with allergies; however, they are only found in the most severe cases.

|Self-Care at Home|

With allergies, “an ounce of prevention is worth a pound of cure.” Avoidance of the allergen(s) is the mainstay in the treatment of allergies. If you can identify and avoid the particular agent that you are allergic to, your symptoms will improve dramatically.

To further help alleviate your symptoms, you may want to try these tips for self-care at home.

• Reduce the allergen load by minimizing clutter where allergens can collect.
  
  
  • Limit pillows, bedding, draperies, and other linens, such as dust ruffles and canopies.
    
    
  • Reduce the number of knickknacks that collect dust.
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• Minimize carpeting that can harbor dust mites.
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• Clean regularly and thoroughly to remove dust and mold.
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• Eliminate water leaks and standing water that encourage mold growth.
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• Use barriers and filters.
  
  
  • Cover mattresses and pillows with allergen impermeable covers.
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  • Use allergen filters in both the furnace and the air conditioner in your home. Also, be sure to change them regularly.
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  • Keep outdoor allergens outdoors by keeping windows and doors closed.
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• Avoid pet dander and other irritants.

Unfortunately, avoidance of the allergen(s) is not always easy or possible. In this case, the following at-home treatments may provide you with some relief from your ocular allergies.

• Apply cold compresses to your eyes to help reduce the allergic reaction.
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• Use artificial tears/lubricating eyedrops as needed to help flush out allergens that get into your eyes.
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• Use over-the-counter medications, such as allergy eyedrops and oral antihistamines, as directed for mild allergies.

|Medical Treatment|

Numerous over-the-counter medications, such as allergy eyedrops and oral antihistamines, can be used as directed for mild allergies. In addition, many prescription eyedrops are also available to help reduce allergies.

|Medications|

Prescription eyedrops are generally very effective, and, because they are applied topically, eyedrops are usually free of many systemic side effects. Most eyedrops are used twice a day, and many can be used to prevent the allergic reaction in the first place. Some common allergy eyedrops include:

• Nedocromil (Alocril)
  
  
• Ketotifen (Zaditor)
  
  
• Olopatadine (Patanol)
  
  
• Azelastine (Optivar)
  
  
• Pemirolast (Alamast)
  
  
• Epinastine (Elestat)

Your ophthalmologist may prescribe cyclosporine A (Restasis). By helping to reduce the inflammatory and/or allergic reaction, cyclosporine A may help decrease your symptoms.

For more serious cases, topical ophthalmic corticosteroids can be used; however, many of the older corticosteroids are associated with ocular side effects with long-term use. The newer ophthalmic corticosteroids have a much lower risk of ocular side effects. Some common topical ophthalmic corticosteroids are:

• Loteprednol 0.02% (Alrex)
  
  
• Loteprednol 0.05% (Lotemax)
  
  
• Prednisolone (AK-Pred)
  
  
• Rimexolone (Vexol)
  
  
• Medrysone (HMS)
  
  
• Fluorometholone (FML, FML Forte, FML Liquifilm)
  
  

|Other Therapy|

To identify those substances that you are most allergic to, skin testing by an allergist may be helpful.

|Follow-up|

Follow-up appointments are scheduled as needed.

• For mild cases of PAC and SAC, annual follow-up visits with an ophthalmologist may be appropriate.
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• For more severe cases or for intermittent exacerbations of normally mild disease, more frequent visits with an ophthalmologist may be required.

|Prevention|

Unfortunately, other than avoidance of the allergen(s), PAC and SAC cannot be prevented.

|Outlook|

Most people with SAC and PAC have nothing to worry about more than it being an annoying inconvenience. Although your symptoms might make the activities of daily living miserable for you, no long-term vision loss is to be expected.

|Support Groups and Counseling|

If you suffer from SAC or PAC, various organizations, including those specializing in eye care and allergy and immunology, provide informational resources. These organizations can also help you to locate an ophthalmologist and/or an allergist in your area. See For More Information and Web Links.

American Academy of Ophthalmology
655 Beach Street
Box 7424
San Francisco, CA 94120
(415) 561-8500
 
American College of Allergy, Asthma & Immunology
85 West Algonquin Road, Suite 550
Arlington Heights, IL 60005
(847) 427-1200

|Web Links|

American Academy of Ophthalmology, Find an Ophthalmologist

American College of Allergy, Asthma & Immunology, How Do I Find an Allergist?

American Academy of Ophthalmology and American College of Allergy, Asthma & Immunology, Eye Allergies and Allergic Conjunctivitis

American Academy of Ophthalmology, Health Tips for Spring Allergies

eye allergies, ocular allergies, seasonal allergic conjunctivitis, SAC, perennial allergic conjunctivitis, PAC, ocular itching, itchy eyes, allergens, eye irritation, allergic reaction, allergic response, conjunctiva

Author: Parag A Majmudar, MD, Fellowship Co-Director, Assistant Professor, Department of Ophthalmology, Cornea and Refractive Surgery Service, Rush-Presbyterian-St Luke's Medical Center.

Coauthor(s): Lauri Graham, Medical Writer, .com, Inc.

Editors: Richard W Allinson, MD, Associate Professor, Division of Ophthalmology, Texas A&M University Health Science Center, Associate Professor, Department of Surgery, Scott and White Clinic; Mary L Windle, Pharm D, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, .com, Inc; Robert H Graham, MD, Ophthalmologist, Robert H Graham, MD, PC; Affiliated With Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona and Carl T Hayden VA Medical Center, Phoenix, Arizona.