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Q. Why do my eyes get so red and itchy?
It's really the same allergic process that causes your nose to run and your throat to itch. Just like in the nose and throat, there are specialized cells called mast cells in the eye. When substances that are allergens -- such as pollen -- hits them, these mast cells release a chemical called histamine. Histamine brings on the itching, redness, and tearing. The allergic process can be seasonal or year-round. The more common seasonal variety is related to allergens from grass, tree and weed pollens, and molds. The year-round form can be triggered by dust mites, animal dander, and feathers.
Q. How do I know if I've got conjunctivitis or "pink-eye?"
If your eyes are red, you do have conjunctivitis. But you don't necessarily have an infection. You see, conjunctivitis simply means inflammation of the conjunctiva -- the membranes covering the eye and the inside of the eyelids. It can be allergic or nonallergic. The three most common types of conjunctivitis are allergic, viral, and bacterial.
In allergic conjunctivitis, your eyes are itchy and red, you may be sneezing, and your nose may run. It is the most common type of allergic eye disease. The eyes are a common site for allergy symptoms because of the vast amounts of blood vessels.
With allergic conjunctivitis you tend to feel better if you can get away from the allergen.
In viral conjunctivitis you'll have burning, discomfort like a foreign body in the eye, and lots of tearing, but your eyes don't really itch, and sometimes there's an associated sore throat. This is what's known as "pinkeye." Because it's caused by a virus, antibiotics won't help.
Then there's bacterial conjunctivitis, which we sometimes call "red eye." It involves more irritation and discomfort rather than itching, and there's a thick white, yellow, or green discharge from the eyes. This is the type of conjunctivitis that needs treatment with antibiotics.
There are some ways you can differentiate between the three types: allergic conjunctivitis usually hits both eyes at the same time, while the infectious types generally start in one eye and can easily spread to the other. Sometimes, however, allergic or viral conjunctivitis can turn into bacterial conjunctivitis, when rubbing or scratching leads to a secondary infection.
Q. When should I see a doctor?
If your symptoms are persistent, if there's any change in your vision, or if you're in pain, you should see your doctor. This may mean that your vision is being threatened.
Q. Why are my symptoms worse when I wear contact lenses?
Normally, tears wash away any foreign substance or irritant. It could be that the contacts are trapping some of these particles and maybe rubbing them into the surface of the eye. Some people find contacts alone to be irritating, so an allergic reaction would only make things worse.
Q. What treatments are available?
The first thing you can do is prevent allergic conjunctivitis by avoiding allergens. That's fairly simple if it's cats or dogs you're allergic to, but it's not as easy if you're allergic to pollen or dust mites, which are everywhere in the environment. In those cases, there are a variety of drugs available, some over-the-counter, but most by prescription. They include antihistamines such as Benadryl, antihistamine/decongestant combinations, and both nonsteroidal and steroidal eyedrops.
Most of the over-the-counter products, such as Visine, are topical decongestants -- they constrict the dilated blood vessels (a process called vasoconstriction). That's what gets the red out. However with continuous regular use the vessels become accustomed to this artificial vasoconstriction, and won't do their own natural decongesting. The eyes may remain red if you stop using it. We call this the rebound phenomenon. It's not permanent, but it could take a while to go back to normal. The same thing happens in the nose with use of decongestant nasal sprays such as Afrin.
Another approach is allergy shots. Rather than taking a medicine to block the histamine reaction or shrink expanded blood vessels, progressively stronger injections of the offending allergens produce immunological changes in the body. The patient becomes "immune" to the allergen over time. It can take three to five years to complete a full course of allergy shots, but many patients feel a big difference in just a few months. And patients with allergic conjunctivitis can feel a very substantial benefit -- often much better than they get with medications.
Other treatments include medications that stabilize cells that release histamine.
Q. Must I remove my contacts before using these medicated eyedrops?
Yes. There are preservatives and stabilizers in the solution that can discolor the lenses. There's also the possibility that the lenses might harden. If they are semi-soft or soft lenses, there could be an interaction between the medication and the plastic. The lenses may also trap the medication, concentrating it and potentially changing its effect.
Q. Are there any natural remedies?
Any natural tears-type product or saline solution will help. Regular eye lubricants help wash out the allergens from the eye. Herbal remedies for the eyes are not regulated by the FDA and have not been proven to be safe or effective. Cold compresses may also help alleviate symptoms.
Q. Will rubbing my eyes do any harm?
Yes, you can damage your eyes, and you will increase the redness. You can break blood vessels. And with contacts it's even worse -- you can get a corneal scratch or tear. And if you break the skin or mucosa of the eye, it becomes more penetrable to bacteria, which can lead to infection of the eye or the skin surrounding the eye.
Q. How can I reduce the irritation and still wear my contacts?
Pretreatment is helpful. Begin taking oral antihistamines, using eyedrops, or getting allergy shots prior to exposure or before the allergy season starts. That should help. Research also indicates that some people who use daily disposable contacts suffer fewer symptoms.
Q. Is there a special lens care routine I should follow?
It would be a good idea to take your lenses out right away if you've had a reaction. This will allow your eye to wash away the allergens. Otherwise, you should continue following the manufacturers cleaning instructions for your lenses, and be sure to disinfect your lens. It can harbor bacteria.
Q. Can allergies affect my eyesight?
Some people who have a skin condition called eczema or atopic dermatitis, which is commonly associated with allergies, are prone to cataracts, which can cause vision loss. And some medications, like steroid eye drops, can make your eyes more susceptible to cataracts or another vision threatening disease called glaucoma. But otherwise, allergies really have no long-term adverse effects on your vision, so long as you take care of your eyes. The cause of any allergy-related vision loss would certainly be complications from a secondary infection -- brought on by rubbing and scratching your eyes. So don't do it!
SOURCES: Lily Pien, MD, a specialist in allergies and asthma, The Cleveland Clinic. American Academy of Allergy and Immunology.
WebMD does not provide medical advice, diagnosis or treatment. See additional information.
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