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Eye Allergy Symptoms: Q&A

[Editor's note: All About Vision receives numerous questions about eye allergies and related symptoms such as bloodshot eyes, eye redness and itching. In this Q&A, All About Vision board member Brian Chou, OD, answers questions about causes, treatments and common symptoms related to eye allergies.]

Symptoms Of Eye Allergies

Q: I believe I have really bad allergies. I get very itchy eyes where I can't even touch them, because this makes the symptoms 10 times worse. I also have a runny nose and watering eyes. Do you think I should go see an eye doctor? Or is there something I can take for it? — B.J.

A: Based on these symptoms, it is definitely a good idea to see an eye doctor. While your symptoms suggest an allergic reaction from some environmental irritant, it is important that an eye doctor rule out less common causes such as parasitic infestation of the eyelids. Proper diagnosis will provide you with the best, most cost-effective treatment, which may range from over-the-counter allergy drops to prescriptive medicine. — Dr. Chou

Q: I started using a new mascara about a week ago. Four days ago, I started to get itchy, red eyes, along with dry eyes and irritation. I also have been using gentamicin eye drops given to me as an antibiotic. Am I having an allergic reaction? Could it be an infection of some kind? Is it just a coincidence that this happened when I started using a new product? My eyes are very itchy, and the vessels are slightly enlarged — S.B.

A: You are correct that you may have an allergic reaction to the mascara and/or the gentamicin drops. Gentamicin is an antibiotic prescribed for treating bacterial eye infections. Some patients are allergic to gentamicin. You should definitely consult your doctor who prescribed the gentamicin.

If you still have a bacterial eye infection, you may be prescribed a new antibiotic to replace the gentamicin. Treatment of allergy involves removing the offending agent and facilitating recovery, often with allergy medicine. — Dr. Chou

Q: I have type 2 diabetes. What does having blurry, itchy, burning eyes mean? — L.M.

A: Without an examination, it is difficult to know whether your symptoms are related to your diabetes. Schedule an appointment with your optometrist or ophthalmologist to make sure your symptoms do not indicate a serious, underlying problem. — Dr. Chou

Eye Drops For Allergies

Q: I have itchy eyes and eyelids. I already use Refresh Tears eye drops. But I wonder if you could help out with some other suggestions? — T.

A: Artificial tears, such as Refresh Tears (Allergan), are somewhat helpful for eye allergy because they dilute the concentration of irritant on the eye surface. However, artificial tears do not prevent the release of chemical substances that start the allergic reaction. In fact, the clinical studies evaluating prescriptive eye drops for allergy frequently use artificial tears as a placebo.

Avoiding the offending agents — commonly dust, pollen and pet dander — is the ideal preventative step. However, it is not always possible to identify and avoid the causative agents (called allergens).

An over-the-counter antihistamine eye drop containing ketotifen (kee-toe-TIE-fen) can effectively manage many cases of common eye allergy. Ketotifen is marketed under several brands, including Zaditor OTC (Novartis), Alaway (Bausch + Lomb), Zyrtec Itchy Eye Drops (McNeil Consumer Healthcare) and Claritin Eye Allergy Relief (Schering-Plough).

For many patients, however, prescriptive allergy eye drops are most effective and potentially more cost-effective than over-the-counter treatments. As an example, clinical studies have shown that olopatadine hydrochloride (Pataday/Patanol, Alcon) eye drops produce better results and are better tolerated when compared with ketotifen.

Your best bet is to have an eye examination to find out what is best for you. — Dr. Chou

Q: I've had red, itchy eyes for months now. This usually occurs at night. No eye drops have helped me. In fact, I have used bottles and bottles of eye drops. — K.

A: It is definitely time for you to seek professional help. Excessive self-dosing of bottled, over-the-counter eye drops can make matters even worse, due to preservative toxicity. All bottled eye drops must contain a preservative to prevent contamination. However, many of these preservatives — when in contact with the eye — can eventually cause chronic eye irritation. Please schedule an examination with an eye doctor. — Dr. Chou

Itchy Eyes And Contacts

Q: For the past day or two, my left eye has been watery, itchy and slightly painful. I am a contact lens wearer. So when I took my lens out, it seemed like my eye started to itch and water even more. — S.B.

My eyes aren't pink or red. They don't have thick mucus, like in pink eye (which I've had in the past). But I don't think it's allergies either, because there is pain in my eye when I use drops, wipe my eye or flush out my eye with water. Also, these symptoms will stop for 10 minutes or so, and then they flare up again. — R.D., Georgia

A: Contact lens wearers experiencing eye pain without improvement should seek an eye doctor's evaluation right away. There are several possible causes, including a corneal infection that could become sight-threatening if not diagnosed and treated rapidly. Please do not delay in seeking proper care. — Dr. Chou

Q: A year ago, I started wearing contacts again. But this didn't last long, because I started having problems with my left eye. I ran out of the solution my doctor gave me to use with the contacts. I had an older, unopened bottle of saline solution that I used instead. That's when I immediately started having problems with the left eye.

A different eye doctor I saw said I had conjunctivitis. I used the eye drops and gel I was given on my eye just like I was supposed to, but the problem never went away. My regular doctor then told me during a routine checkup that I probably just had allergies. I tried Zaditor, but this didn't help, either.

My eye is still itchy and swollen. I still get mucus — both clear and yellow. My eye is still encrusted when I wake up, and it continues to leak during the day. This is so tedious and bothersome. What could it be? — B.

A: First of all, you should always use the contact lens care system that your eye doctor recommends. Contact lens multipurpose solution is not the same thing as saline. Contact lens solutions are carefully engineered to:

  • Disinfect against microorganisms that can cause eye infections in a manner that meets or exceeds requirements.

  • Clean the lenses of mineral, protein and lipid deposits.

  • Condition the lenses so that they are moist and comfortable.

All the aforementioned functions of the lens solution also must occur with minimal toxicity to the eye surface. If you are using saline rather than your doctor-recommended contact lens solution, you are unnecessarily putting your eye health at risk, because saline does not provide any disinfection.

To address your other point, Zaditor OTC (Novartis) is an over-the-counter allergy eye drop. Given that your symptoms did not improve with using that drop, it is unlikely that you are experiencing eye allergy. It is even possible that you may have some type of eye infection.

Your continuing eye problem deserves prompt re-evaluation by an eye doctor — not just a general practitioner. Rather than seeing a new doctor each time, you should consider developing a relationship with the same eye doctor so that you have continuity in the care. Consider scheduling an appointment with one of the eye doctors you've already seen. Proper diagnosis enables effective treatment. — Dr. Chou

Eye Allergies And Environment

Q: Every day at work my eyes get really red and itchy. We just moved into a different building, and many of us working here are experiencing the same symptoms, which we never had before.

Could chemicals in the air conditioner do this? The building has a manufacturing plant downstairs that works a lot with plastics and items such as that. It sometimes smells like burning plastic here.

Are we in danger of chemical exposure? Our eyes don't lie, they disapprove. — A.

A: It's logical to suspect that your new environment underlies the symptoms that you and your co-workers are having. If you haven't already done so, report this problem to your employer.

Everyone deserves a safe, healthy work environment, so you also might want to seek guidance from the Occupational Safety & Health Administration (OSHA). Meanwhile, it's a good idea to schedule an examination with an eye doctor. — Dr. Chou

Eye Allergies In Children

Q: My son is 7 years old. For many days he has been blinking a lot, and he says his eyes are very itchy. Due to this, he keeps rubbing his eyes. Is this due to allergy? — S.S.

A: Allergy is a likely cause. An eye doctor can properly evaluate your son and offer a definitive diagnosis with an appropriate treatment regimen. An examination by an eye doctor also can rule out rare eye conditions, such as keratoconus, which is associated with eye rubbing. — Dr. Chou

Q: My 11-year-old son went to an eye infirmary because his eyes were very itchy and sore. He also found it difficult to keep his eyes open. After a long examination, the doctor told me he had allergic conjunctivitis with dry eyes. Because his eyes were not watery and did not have pus, the doctor said this was rare.

My son was given Refresh Celluvisc for dry eyes and also Cromolux and Alomide eye drops for allergies. He used these four times daily.

Then, at a follow-up appointment a week later, a different doctor told us that there was nothing wrong with him and that children do not get dry eyes. Now, after two days of not using the drops, my son has the symptoms again. What should we do? And what is the difference between dry eyes and allergies? — H.B.

A: It is understandably frustrating to get conflicting information from different eye care professionals. I would recommend contacting your son's first eye doctor and expressing your concern over the conflicting information. Communication is an important element of any patient-doctor relationship, and can lead to better treatment outcomes.

Dry eye and allergies are two different conditions, but they can co-exist. Dry eye is more prevalent in the older population even though it also can affect children. Dry eye refers to inadequate tears on the eye surface. Allergy is an overreaction of the immune system to various substances, which commonly include dust, pollen and pet dander. Eye allergies typically make your eyes itchy, red and watery. — Dr. Chou

Q: My daughter gets very swollen eyes (top and bottom), although her eyes are very clear. There is no eye discharge, but her eyelids are so swollen that they are almost closed shut. Then it goes away with one eye and returns in the other eye.

She said her eyelids are itchy and hurt when she touches them. Her doctor said nothing can be done because this is not an infection. This has happened twice in the last two months. How can we prevent this from happening again? It looks like she has been in a fight! — C.

A: What you've described does not sound normal. If your daughter has seen only a general doctor, it is a good idea for her to see an eye doctor, too. Several conditions may cause eyelids to swell, including infection of the oil-producing glands within them. It would be a good idea to find out for sure from an eye specialist. — Dr. Chou

Q: My 4-year-old son has a thick film above the iris of both eyes. He says he can see fine. He started having itchy eyes a few weeks ago from allergies, but I'm concerned about this film above the iris that doesn't go away. — H.P.

A: Young children often are surprisingly tolerant of poor vision and eye irritation, perhaps because they do not know what is "normal." An eye doctor can determine your son's condition and rule out a specific type of eye allergy called vernal conjunctivitis that can cause eye discharge and itching. — Dr. Chou

Red, Bloodshot Eyes

Q: I'm a 15-year-old male. This year I have suffered from allergic conjunctivitis on two occasions. This always started as an irritating itch, which caused me to rub my eyes during the night. Then my eyes were red, possibly from an allergic reaction to dust or dust mites.

But now I wake up every morning with red, inflamed veins. My eyes sometimes are itchy, and the spot where it itches is inflamed. I use my old allergic conjunctivitis "get the red out" eye drops, but they aren't working. It has been seven weeks now and I'm starting to get worried. — S.

A: Please have your parent or guardian schedule you for an appointment with an eye doctor right away. Seven weeks is a long time to let something like this go on.

For mild, occasional eye redness, it is fine to sparingly use the over-the-counter eye drops for reducing eye redness, called vasoconstrictors. Common active ingredients in vasoconstrictor drops include tetrahydrozoline, naphazoline and oxymetazoline.

However, people who use these eye drops several times daily can experience a "rebound" effect where — upon stopping these drops — their eyes get even redder than before. Dependency on vasoconstrictors requires slowly tapering off these medicines rather than abruptly stopping them altogether. — Dr. Chou

Watery Eyes And Light Sensitivity

Q: This past summer, I had a severe allergic reaction in my eyes that came on suddenly and lasted for a few days. I've never before had any seasonal allergies, and I never had any allergies that affected my eyes.

My eyes were not itchy, but they watered so much that I couldn't keep my eyes open or focused on anything. Keeping my eyes closed didn't provide relief, and my eyelids felt very warm.

The ER doctor gave me some eye drops, but he never told me what caused the allergic reaction. The only thing I can think of is that I was exposed to aerosol insect spray that contains DEET. However, I don't think it was near my eyes at all, and it didn't touch my eyes.

For more than a week after the reaction stopped, my eyes were very light sensitive. I'm wondering what this was. I've never heard of anything like it. — C.S.

A: It may be impossible to know for sure what happened, including if it was related to the aerosol spray. If it ever happens again — and hopefully it never will — you should first see an eye doctor. Even though ER physicians are trained to handle a broad number of health ailments, an eye doctor's office is specifically equipped for examining the sensitive eye tissue, which is a significant advantage for accurate diagnosis and rapid treatment. — Dr. Chou

Q: While I was pregnant, I started having itchy, irritated eyes that were also sensitive to light. Now that my child is a year old, I still have itchy, scratchy eyes.

My eye doctor gave me eye drops to try, which I use two to three times daily. How can I know if this is caused by dry eyes or allergies? — L.V.

A: Itching is a classic symptom of eye allergy, while burning is a classic symptom of dry eye — however, neither of these symptoms is diagnostic alone. Please consult your eye doctor for the diagnosis in your situation.

Women who are pregnant or breast feeding should always let their eye doctor know. Certain prescriptive medicines are not appropriate in such cases. — Dr. Chou

Please note: If you have an urgent question about your eye health, contact your eye care practitioner immediately. This page is designed to provide general information about vision, vision care and vision correction. It is not intended to provide medical advice. If you suspect that you have a vision problem or a condition that requires attention, consult with an eye care professional for advice on the treatment of your own specific condition and for your own particular needs. For more information, read our Terms of Use.

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