Red, Itchy, and Watery Eyes – Oh My!

By Craig Moffat MD

When your eyes are exposed to allergens, histamine is released and reddening, itching, and tearing of the eyes quickly ensue. Learn about Allergic Conjunctivitis and what you can do to treat it.

red eyes by allergic conjunctivitis pinkeye

Allergic Conjunctivitis, more commonly known as Pinkeye, 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.

Have allergies but not experiencing Pinkeye? Learn more about allergy immunotherapy to treat allergic rhinitis (nasal symptoms), allergic asthma, stinging insect allergy, and atopic dermatitis (eczema).

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 Conjunctivitis or Hay Fever include grasses, ragweed, and 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 or perennial 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 to diagnose and prescribe a treatment:

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

Treatment

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

Lubricating eye drops can also help decrease symptoms. Additionally, you can relieve discomfort by applying cool compresses to the eyes or using over-the-counter oral antihistamines. However, they can sometimes make the eyes dry. 

If home-care measures do not help, you may need treatment by a health care provider. These may include antihistamine drops, anti-inflammatory drops, or mild eye steroid drops (for more severe reactions).

You may also use eye drops that prevent mast cells (a type of white blood cell) 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 are continually exposed to the allergen.

Complications

There are no serious complications besides general discomfort.

Calling your health care provider

Call your health care provider for an appointment if you are experiencing allergic conjunctivitis and it is not responding to over-the-counter treatment.

 

References

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002026

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.