Dr. Jay Woody is a diplomat of the American Board of Emergency Medicine, a Fellow of the American College of Emergency Medicine and is an Attending Physician at Parkland Health and Hospital System, Children's Medical Center of Dallas as well as several other north Texas facilities. He is a well-known and widely published authority in the field of emergency medicine and the former regional medical director of a freestanding emergency medicine practice.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
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.
What are allergic eye conditions?
Allergic conjunctivitis
Allergic conjunctivitis, also called "allergic rhinoconjunctivitis," is the most common allergic eye disorder. The condition 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. Typical complaints include itching, redness, tearing, burning, watery discharge, and eyelid swelling. To a large degree, the acute (initial) symptoms appear related to histamine release.
The treatments of choice are topical antihistamine drops such as olopatadine (Patanol), decongestants, and the newer mast-cell stabilizer 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 like loratadine (Claritin) or cetirizine (Zyrtec) are the least effective option, but they are often used for treating allergic rhinitis together with allergic conjunctivitis.
Allergy assist
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. Translation: Do not rub your eyes!
Conjunctivitis with atopic dermatitis
Commonly called "atopic keratoconjunctivitis," this condition is a notorious cause of severe eye changes, particularly in young adults. Atopic keratoconjunctivitis implies inflammation of both the conjunctiva and cornea. "Kerato" means pertaining to the cornea. This form of conjunctivitis usually affects adolescent boys (three times more frequently than girls) and is more common in those who had atopic dermatitis in early childhood. The condition is characterized by intensely itchy, red areas that appear on the eyelids. A heavy discharge from the eyes can occur, and the skin of the eyelid may show scales and crusts. In severe cases, the eyes become sensitive to light, and the eyelids noticeably thicken. If managed poorly, there can be permanent scarring of the cornea due to chronic rubbing and scratching of the eyes. This scarring can cause visual changes.
The triggers for atopic keratoconjunctivitis appear to be similar to those of atopic dermatitis. A search for common food allergies, such as eggs, peanuts, milk, soy, wheat, or fish is important. Airborne allergens, particularly dust mites and pet dander, have been overlooked as a significant contributing factor and should be evaluated and controlled.
The hallmark of treatment for allergic conjunctivitis is the use of potent antihistamines (similar to those used in atopic dermatitis) to subdue the itching. Topical antihistamines, mast-cell stabilizers, and the short-term use of oral steroids are all beneficial for relief of the itching. Occasionally, an infection of the area (usually with staphylococcus, commonly referred to as "staph") worsens the symptoms, and antibiotic treatment may help control the itching. Allergy shots are useful in selected cases.
Allergy alert
Atopic keratoconjunctivitis can lead to cataract
formation in up to 10% of cases. In rare cases, blindness
can occur.
Vernal keratoconjunctivitis
Vernal keratoconjunctivitis is an uncommon condition that tends to occur in
preadolescent boys (3:1 male to female ratio) and is usually outgrown during the
late teens
or early adulthood. (Vernal is another term for "spring.")
Vernal keratoconjunctivitis usually appears in the late
spring and particularly occurs in rural areas where dry,
dusty, windy, and warm conditions prevail. The eyes become
intensely itchy, sensitive to light, and the lids feel
uncomfortable and droopy. The eyes produce a "stringy"
discharge and, when examined, the surface under the upper
eyelids appears "cobblestoned." A closer examination of
the eye reveals severe inflammation due to the vast number
of mast cells and accumulated eosinophils (a type of white blood cell involved in the allergic response), producing so-called
called "Trantas dots."
Improper treatment of vernal keratoconjunctivitis can
lead to permanent visual impairment. The most effective
treatment appears to be a short-term course of low-dose
topical steroids. Topical mast-cell stabilizers and
topical antihistamines can also be beneficial. Wraparound
sunglasses are helpful to protect the eyes against wind and dust.
Allergy fact
Keratitis, or the inflammation of the cornea, in vernal
and atopic keratoconjunctivitis is largely caused by a
substance that is released from the eosinophils called
major basic protein.
Giant papillary conjunctivitis (GPC)
This condition is named for its typical feature, large
papillae, or bumps, on the conjunctiva under the upper
eyelid. These bumps are likely the result of irritation
from a foreign substance, such as contact lenses. Hard,
soft, and rigid gas-permeable lenses are all associated
with the condition. The reaction is possibly linked to the
protein buildup on the contact lens surface. This condition is believed, in part, to be due to an allergic reaction to either the contact lens itself, protein deposits on the contact lens, or the preservative in the solution for the contact lenses. Redness and
itching of the eye develop, along with a thick
discharge.
Allergy to contact lenses is most common among wearers of hard contact lenses and is least common among those who use disposable lenses, especially the one-day or one-week types. Sleeping with the contact lenses on greatly increases the risk of developing GPC.
The most effective treatment is to stop wearing the
contact lenses. Occasionally, changing the type of lens in
addition to more frequent cleaning or using disposable
daily wear lenses will prevent the condition from
recurring.
The giant papillae on the conjunctiva, which are characteristic of GPC, however, may
persist for months despite these measures. Eye medications, such as cromolyn (Opticrom) or lodoxamide (Alomide), often are used in this condition, sometimes for several months. Contact lenses should not be worn while these medications are being used.
Eczema, also known as dermatitis, is a general term for many types of skin inflammation. The most common form of eczema is atopic dermatitis. The other forms of eczema include: contact eczema, seborrheic eczema, Nummular eczema, Neurodermatitis, stasis dermatitis, and dyshidrotic eczema. Symptoms, diagnosis, and treatment of eczema may vary from person to person and may depend on the type of eczema.
Pink eye, also called conjunctivitis, is redness or irritation of the conjunctivae, the membranes on the inner part of the eyelids and the membranes covering the whites of the eyes. These membranes react to a wide range of bacteria, viruses, allergy-provoking agents, irritants, and toxic agents.
A sty (sometimes spelled stye) is a tender, painful red bump located at the base of an eyelash or on, inside, or under the eyelid, which is the result of an acute infection of the oil glands of the eyelid. Complications of a sty can be blepharitis and chalazion.
Itching can be a common problem. Itches can be localized or generalized. There are many causes of itching to include: infection (jock itch, vaginal itch), disease (hyperthyroidism, liver or kidney), reactions to drugs, and skin infestations (pubic or body lice). Treatment for itching varies depending on the cause of the itch.
Hashimoto's thyroiditis is the most common cause of hypothyroidism in the US. This conditions is caused by inflammation of the thyroid gland. Symptoms may include: fatigue, weight gain, cold intolerance, excessive sleepiness, dry or coarse hair, difficulty swallowing, a lump in the front of the throat, and many more. Treatment is usually hypothyroid medication.
Asthma is a common disorder in which
chronic inflammation of the bronchial tubes (bronchi) makes them swell, narrowing the airways. Signs and symptoms include shortness of breath, chest tightness,
cough and wheezing.
An allergy refers to a misguided reaction by our immune system in response to bodily contact with certain foreign substances. When these allergens come in contact with the body, it causes the immune system to develop an allergic reaction in people who are allergic to it. It is estimated that 50 million North Americans are affected by allergic conditions. The parts of the body that are prone to react to allergies include the eyes, nose, lungs, skin, and stomach. Common allergic disorders include hay fever, asthma, allergic eyes, allergic eczema, hives, and allergic shock.
Common sources of indoor allergens include dust mites, cockroaches, molds, pets, and plants. Managing allergies caused by indoor allergens means reducing your exposure to them.
Children's health is focused on the well-being of children from conception through adolescence. There are many aspects of children's health, including growth and development, illnesses, injuries, behavior, mental illness, family health and community health.
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