Ocular allergies, also known as “allergic conjunctivitis”, are caused by a reaction of the immune system to substances that come into contact with the eye and lead to inflammation. The most common cause of ocular allergies is exposure to allergens such as pollen, mold, mites, and certain medications.
Ocular allergies (Allergic conjunctivitis)
Allergies manifest through redness of the eyes, swelling, itching, and excessive tearing.
The duration of an ocular allergy can vary. Some allergic reactions last less than an hour or a day, while others can persist for several weeks or months, especially in the case of seasonal allergies
Learn more about:
- Causes of ocular allergies
- Symptoms of ocular allergies
- Types of ocular allergies
- Diagnosing ocular allergies
- Ocular allergy treatment: Medicinal and natural
- Complications of ocular allergies
Causes of ocular allergies
Ocular allergy occurs when the body’s immune system reacts to an allergen that is normally harmless. When an allergen comes into contact with your eye, certain cells inside the eye (mast cells) release histamine and other substances to fight against the allergen. This reaction causes eyes to become red, to cause itching and hyper lacrimation.
There are several types of allergens. Airborne allergens are the most common:
- Pollen from grass, trees, and ragweed
- Dust
- Pet dander (dead skin from dogs, cats, and other animals)
- Mold
- Smoke
Allergic reactions to perfume, cosmetics, or medications can also cause an allergic response in the eyes.
Some people may be allergic to preservatives in artificial tears or prescribed eye drops.
Sometimes, the eyes can react to allergens that do not necessarily come into direct contact with the eye. These can be certain foods or insect bites.
Some people inherit ocular allergies from their parents. It’s more likely to face allergies if both parents have them, than if just one does.
Ocular allergies: Symptoms
Ocular allergies do not pose a major risk to visual acuity. However, they can cause temporary blurred vision.
You can start having symptoms as soon as the eyes come into contact with the allergen or you might not have symptoms for up to 4 days.
The signs of ocular allergies are:
- Red, irritated eyes
- Itchy sensation in the eyes
- Watery eyes
- Swollen eyelids
- Discomfort, pain, or burning sensation
- Sensitivity to light (photophobia)
These may also be accompanied by other symptoms such as: runny nose, stuffy nose, and sneezing.
Types of ocular allergies
The main types of ocular allergy are: seasonal allergic conjunctivitis, perennial allergic conjunctivitis, vernal keratoconjunctivitis, atopic keratoconjunctivitis, contact allergic conjunctivitis, and giant papillary conjunctivitis.
1. Seasonal allergic conjunctivitis
Seasonal allergic conjunctivitis is the most common type of ocular allergy. Usually, patients have symptoms in spring, summer, or fall, depending on the pollen that affects them. Symptoms of seasonal allergic conjunctivitis include:
- Itchiness
- Redness
- Burning sensation
- Clear, watery discharge
- Sensitivity to light
People may have chronic dark circles (known as allergic shiners). Eyelids may be swollen, and bright lights can be bothersome. The itchiness can create such discomfort that patients rub their eyes, worsening symptoms and increasing the risk of infections.
The basic symptoms are often accompanied by sneezing, nasal discharge or congestion, associated with “hay fever” and other seasonal allergies.
2. Perennial allergic conjunctivitis
Perennial allergic conjunctivitis occurs throughout the year. Symptoms are the same as for seasonal allergic conjunctivitis, but tend to be milder.
This type of allergy is caused by reactions to mites, mold, animal skin residues, or other indoor allergens.
3. Vernal keratoconjunctivitis
Vernal keratoconjunctivitis is a more severe form of ocular allergy. It is more common in young people and in male individuals. Also, 75% of patients also have eczema or asthma.
Although it can occur throughout the year, symptoms may worsen during certain periods. The main signs of the eye disease are:
- Itchiness
- Excessive tearing
- Thick mucus discharge
- Foreign body sensation in the eye
- Sensitivity to light
Untreated, vernal keratoconjunctivitis can seriously affect vision.
4. Atopic keratoconjunctivitis
This type of allergy mainly affects older patients – especially men with a history of allergic dermatitis.
Symptoms of atopic keratoconjunctivitis can occur throughout the year and are similar to those of vernal keratoconjunctivitis:
- Severe itching
- Burning sensation
- Redness
- The excessive secretion of thick mucus which, after sleep, can cause the eyelids to stick together
If not treated, atopic keratoconjunctivitis can lead to corneal scarring.
5. Contact allergic conjunctivitis
This can result from irritation caused by contact lenses or by proteins in tears that adhere to the lens surface.
Symptoms for contact allergic conjunctivitis are:
- Redness
- Itchiness
- Mucous discharge
- Discomfort at the level of the vision lens
6. Giant papillary conjunctivitis
Giant papillary conjunctivitis is a severe form of contact allergic conjunctivitis, in which papules form in the upper layer of the inner eyelid. The papules are like individual “sacs” of fluid.
This eye disorder is also associated with the use of contact lenses.
Symptoms include:
- Itchiness
- Inflammation
- Tearing
- Mucous discharge
- Blurred vision
- Decreased tolerance to wearing contact lenses
- Foreign body sensation in the eye
Diagnosing ocular allergies
Ocular allergies are quite easily diagnosed. During the eye examination, the doctor will initially ask you about your medical history and your family’s allergy history.
Then, the doctor will use a biomicroscope (a microscope with a bright light), to examine the eye. The doctor will look for inflamed blood vessels on the surface of the eye, infections, and other symptoms of ocular allergies.
An ophthalmologist can also test you for a certain type of white blood cells, by evaluating a small portion of the conjunctiva tissue. This test is done if the allergy is severe or if it’s not clear that you suffer from allergic conjunctivitis.
Treatment: Ocular allergies
Avoiding allergens
The first step in managing seasonal or perennial forms of ocular allergies is avoiding the allergens that trigger symptoms.
A. Exposure to the environment:
- Stay indoors as much as possible when pollen concentrations are higher (usually in the morning and early evening, or when the wind spreads the pollen).
- Wear sunglasses outdoors to minimize the amount of pollen that gets into your eyes.
- If you have itching, try not to rub your eyes, as you will irritate them and worsen the condition.
- Keep windows closed and use air conditioning in the car and at home (constantly clean the air filters).
- Reduce exposure to mites, especially in the bedroom. Use antibacterial covers for pillows, duvets, and mattresses. Wash bed linen frequently, using hot water (at least 60 degrees Celsius).
- To limit exposure to mold, keep humidity in the house at a low level (between 30 and 50%) and regularly clean bathrooms, kitchens, and basements. Use a dehumidifier, especially in the basement and other damp places. Empty and clean it often.
- If mold is visible, clean it with detergent and a solution with at least 5% chlorine.
B. Contact with pets:
- Wash your hands immediately after petting any animal. Wash your clothes after visiting friends with pets.
- If you are allergic to a household animal, keep it as far away from your room as possible.
- If the animal must be indoors, keep it away from the bedroom to not be exposed to its residues. Replace carpet with hardwood, tile, or linoleum, all of which are easier to clean.
However, most allergens that trigger ocular allergies are airborne, so you can’t always avoid them. Discuss your symptoms with an allergist, to determine which eye treatment options are most suitable for you.
2. Ocular allergies: over-the-counter drops and treatment
Eye drops and oral medications without a prescription are usually used for short-term symptom relief. These do not treat all the issues and, in some cases, there’s a risk that the eye drops might actually worsen your condition. Therefore, it’s mandatory to discuss with a specialist doctor, to choose the best option for you.
Artificial tears
They are recommended to temporarily remove allergens and to moisturize dry eyes. The drops also reduce redness and irritation. They can provide additional relief and comfort, are safe and can be used as often as needed. It’s advisable to keep them refrigerated.
- Decongestant drops
Reduce the redness associated with ocular allergies, by narrowing the blood vessels in the eyes. They are available either as a decongestant, or as a decongestant together with an antihistamine, which provides additional relief for the itching sensation. Because the drops are light, they must be used frequently (4-6 times/day).
However, they should not be used for more than 2-3 days. Prolonged use can create a “rebound effect” (severe swelling and redness that persist even after stopping the drops). You might be familiar with this if you have used decongestant nasal sprays for more than 3 days and your nose became even more blocked than it was before.
Decongestant drops should not be used by people with glaucoma.
- Oral antihistamines
Although oral antihistamines can be effective in relieving the itchiness associated with ocular allergies, they might cause dry eyes and worsen the symptoms of ocular allergies. Also, some variants of these medicines can cause side effects such as drowsiness or dizziness.
3. Ocular allergies: prescription drops and treatment
There are also prescription eye drops and oral medications used in the treatment of ocular allergies.
- Antihistamine drops
These can reduce itching, redness, and inflammation. Although these drops provide quick relief, the effect can last only a few hours, and some need to be used 4 times/day.
Mast cells stabilizer drops (cells in the connective tissue of the eye)
They prevent the release of histamine and other substances that cause allergy symptoms. To prevent itching, the drops should be used before exposure to the allergen.
Antihistamine and mast cells stabilizer drops
Some of the newest drops have both an antihistamine and a mast cell stabilizer for treating and preventing ocular allergies. They are used twice a day and provide quick and lasting relief of symptoms.
- Drops with nonsteroidal anti-inflammatory substances
Nonsteroidal anti-inflammatory medication is available in the form of drops to relieve itching. They may cause stinging or burning upon application and may need to be used 4 times/day.
- Corticosteroid drops
These can help treat chronic and severe symptoms of ocular allergies, such as itching, redness, and inflammation. Long-term treatment with steroids (more than 2 weeks) should be carried out only under the supervision of an ophthalmologist.
Side effects of continuous use include a high risk of infection, glaucoma, and cataract.
- Antihistaminice orale nesedative
Antihistaminicele eliberate pe bază de prescripție medicală pot fi eficiente în ameliorarea mâncărimii provocate de alergiile oculare. Deși acestea nu au aceleași efecte secundare sedative ca antihistaminicele fără prescripție medicală, ele pot agrava simptomele și pot cauza ochi uscați.
- Non-sedative oral antihistamines
Prescription-based antihistamines can be effective in relieving the itchiness caused by ocular allergies. Although they do not have the same sedative side effects as over-the-counter antihistamines, they can worsen symptoms and cause dry eyes.
4. Ocular allergies: natural remedies
These remedies can be used in combination with prescribed or over-the-counter medications prescribed by an ophthalmologist. A few options would be:
- Cold compresses: Applying a cold compress to the affected eye can help reduce inflammation and relieve itching.
- Drops and saline solution rinses: Rinsing the eyes with a saline solution can help remove allergens and reduce inflammation.
It is important to note that these remedies are not a substitute for medical treatment and should not be used in place of medications recommended by an allergy specialist.
Ocular allergies in children
Children can be treated with ophthalmic drops and prescription-based medication. Artificial tears are safe and can be used at any age. Certain drops, such as antihistamines and mast cells stabilizers, can be used in children aged 3 years or older. Any treatment should be discussed with a specialist doctor, during a pediatric consultation.
Complications of ocular allergies
In rare cases, contact with allergens can cause anaphylaxis (anaphylactic shock), an extreme and possibly fatal allergic reaction. Anaphylaxis is signaled by:
- Swollen throat, lips or tongue
- Breathing difficulties
- Skin rashes or hives
- High pulse
- Dizziness, feeling faint or even fainting
- Change in face or body color (becoming pale or red)
- Gastrointestinal pains
- Vomiting or diarrhea
If you are dealing with ocular allergies, but have never seen a specialist, schedule an examination at one of the Dr. Holhoș clinics. The ophthalmology network is present in Cluj-Napoca, Turda, Alba-Iulia, Sibiu, and Mediaș. The team of experts and state-of-the-art ophthalmologic technology will make you feel safe and guarantee the best treatment for you.
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