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Allergic conjunctivitis

Definition

Allergic conjunctivitis occurs when the clear layer of tissue lining the eyelids and covering the white of the eye (conjunctiva) become swollen or inflamed due to a reaction to pollen, dander, mold, or other allergy-causing substances.

Alternative Names

Conjunctivitis - allergic seasonal/perennial; Atopic keratoconjunctivitis

Causes, incidence, and risk factors

When your eyes are exposed to anything to which you are allergic, histamine is released and the blood vessels in the conjunctiva become swollen. Reddening of the eyes develops quickly, along with itching and tearing.

The pollens that cause symptoms vary from person to person and from area to area. Tiny, hard-to-see pollens that may cause hay fever include:

  • Grasses
  • Ragweed
  • Trees

The amount of pollen in the air can affect whether you develop symptoms. There is more likely to be increased amounts of pollen in the air on hot, dry, windy days. On cool, damp, rainy days most pollen is washed to the ground.

Allergies tend to run in families, although they are not inherited in any obvious way. It is hard to know exactly how many people have allergies, because many different conditions are often lumped under the term allergy.

Symptoms

Symptoms may be seasonal and can include:

  • Intense itching or burning eyes
  • Puffy eyelids, especially in the morning
  • Red eyes
  • Stringy eye discharge
  • Tearing (watery eyes)
  • Widened (dilated) vessels in the clear tissue covering the white of the eye

Signs and tests

Your health care provider may look for the following:

  • Certain white blood cells, called eosinophils
  • Small, raised bumps on the inside of the eyelids (papillary conjunctivitis)
  • Positive skin test for suspected allergens on allergy tests

Treatment

The best treatment is to avoid what causes your allergy symptoms. It may be impossible to avoid all of your triggers. However, you can often take steps to reduce your exposure to triggers such as:

Lubricating eye drops can help decrease symptoms. You can relieve discomfort by applying cool compresses to the eyes. Over-the-counter oral antihistamines can provide more relief. However, they can sometimes make the eyes dry. 

If home-care measures do not help, you may need treatment by a health care provider. This may include:

  • Antihistamine or anti-inflammatory drops
  • Mild eye steroid drops (for more severe reactions)

You may also use eye drops that prevent certain white blood cells, called mast cells, from releasing histamine. These drops are given along with antihistamines for more severe symptoms. They work best if you take them before coming into contact with the allergen.

Expectations (prognosis)

Treatment often relieves symptoms, but they can return if you continue to be exposed to the allergen.

Complications

There are no serious complications, although discomfort is common.

Calling your health care provider

Call for an appointment with your health care provider if you experience allergic conjunctivitis and it does not respond to over-the-counter treatment.

References

Haq SM, Singh S, Song BJ, Trocme SD. Ocular allergic disorders. In: Tasman W, Jaeger EA, eds. Foundations of Clinical Ophthalmology. 2012 ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2012: vol 2, chap 30.

Bielory L, Friedlaender MH. Allergic conjunctivitis. Immunol Allergy Clin North Am. 2008;28(1):43-58.

Stock EL, Meisler DM. Vernal keratoconjunctivitis. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology On DVD-ROM. 1st ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2012:chap 9.


Review Date: 9/3/2012
Reviewed By: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington; and Franklin W. Lusby, MD, Ophthalmologist, Lusby Vision Institute, La Jolla, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
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