Author: Marta McKeague, MD
The recent warmer weather is a welcome change after a long, cold winter, but for people with seasonal allergies, the change in weather is also a harbinger of unwelcome symptoms. Seasonal allergies or hay fever affect roughly 8% of the population in the U.S. and many of these patients also suffer from associated eye symptoms, such as allergic conjunctivitis. This is inflammation of the conjunctiva (the thin covering of the whites of the eyes and the lining of the inside of the eyelids) that is caused by immune cells reacting to allergens and releasing an inflammatory substance called histamine.
Many people experience seasonal allergies as a response to the seasonal release of environmental allergens, such as tree, weed, or grass pollens in spring and early summer, and ragweed pollen in early fall. However, some people experience year-round allergies, which are usually triggered by indoor allergens such as dust mites and animal dander. Allergic conjunctivitis can also be caused by cosmetics and eye drops. The most common symptoms of allergic conjunctivitis are eye redness, itching of eyes and eyelids, excessive tearing, pain, and eyelid swelling. The symptoms can range from mild to severe.
While avoiding allergens can be very helpful in preventing symptoms, it is not always possible. Measures that can help with hay fever include staying at home, keeping windows closed, and using air conditioning during high pollen and mold seasons, as well as wearing sunglasses and a wide-brimmed hat to keep the pollen out of the eyes whenever out. For managing year-round indoor allergies at home, helpful steps include reducing soft coverings, such as carpets; frequent vacuuming; using allergen covers for pillows, duvets, and mattresses; and frequent washing of bed linens.
Other measures that can help to alleviate symptoms of allergic conjunctivitis include using cold compresses and artificial tears to dilute and wash away allergens on the ocular surface. Every effort should be made to reduce eye rubbing, as this can not only worsen symptoms of allergic conjunctivitis, but also cause rubbing-related injury such as corneal abrasions. Chronic eye rubbing is harmful because it can contribute to the development of a condition called keratoconus, which affects vision.
Pharmacological treatment of allergic conjunctivitis can consist of both eye drops and oral medications, many of which are available over the counter. Eye drops include olopatadine (Pataday, Patanol, Pazeo), ketotifen (Zaditor, Alaway), azelastine, bepotastine (Bepreve), cetirizine (Zerviate), cromolyn (Crolom), and many others. One thing to keep in mind is that many over-the-counter allergy-drop formulations include vasoconstrictors. These medications help to reduce eye redness and other symptoms, but cause reduced effectiveness with continued use and rebound redness upon treatment discontinuation. Oral antihistamines, such as diphenhydramine (Benadryl), cetirizine (Zyrtec), loratadine (Claritin), and fexofenadine (Allegra) can treat other symptoms simultaneously, such as runny nose and sneezing. Watch out for drowsiness, though, which is the most common side effect of oral antihistamines. Choose non-drowsy formulas and avoid driving or operating heavy machinery when using these medications for the first time.
In some cases, the treatments mentioned above might not be effective and patients may require corticosteroid eye drops. These should only be used for a short time and under close supervision of an eye doctor due to their potential side effects, such as elevated intraocular pressure and cataract formation. Some refractory and severe cases may benefit from a consultation with an allergist and treatment with allergy shots (allergen immunotherapy).
Many severe cases of allergic conjunctivitis may not be caused by simple environmental allergies, but instead are due to atopic keratoconjunctivitis (commonly seen in patients with asthma and eczema, with no seasonal variation), vernal keratoconjunctivitis (commonly seen in boys between ages 5 and 20, with seasonal exacerbations possible), and giant papillary conjunctivitis (commonly seen in individuals wearing soft contact lenses). If you are experiencing symptoms suggestive of allergic conjunctivitis and are not responding to conservative measures, it would be prudent to seek consultation with an ophthalmologist.
If you would like more information about eye allergies, one of our excellent eye doctors at OCLI Vision would be glad to discuss treatment options that will help you face the warmer months ahead without suffering from allergic conjunctivitis symptoms. To schedule an appointment, please call 833-509-6254 or fill out the appointment form below.