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Allergic Conjunctivitis

What is allergic conjunctivitis?

Allergic conjunctivitis is a reaction of the eye to things in the environment such as dust, pollen, animal dander, and medications. It is not an infection and is not contagious but can be very bothersome.

What causes allergic conjunctivitis?

Seasonal allergic conjunctivitis (SAC) occurs when a person comes into contact with something like pollen or mold that he/she is sensitized to. Spring, summer and fall allergies tend to be due to what is blooming outside during those times. Allergies in the winter time tend to be due to house dust, animal hair and things that are blown around the house by the furnace. The dry air in the winter time can make the condition worse.

What symptoms will my child have?

Most frequently there will be itching. The conjunctiva (the thin membrane covering the white part of the eye and the inside of the eyelids) will be pink and bloodshot [See figure 1]. The conjunctiva can swell so it looks like a clear blister on the surface of the eye. Other symptoms often encountered include stinging, tearing, and burning. The eyelid skin is very thin so it can become very swollen. Many children rub their eyes constantly. Unfortunately this tends to make the swelling and itching worse, but even adults find it hard to not rub their eyes.

Fig. 1 Symptoms of allergic conjunctivitis include a pink and bloodshot conjunctiva.

Is allergic conjunctivitis the same as “pink-eye”?

No. While the eye with allergies is usually blood shot or pink, it is not contagious. The term “pink eye“ usually indicates a contagious infection from viruses or bacteria. While some symptoms may be similar, usually pink-eye from a virus will be more irritating with a greater amount of tearing and discharge. Discolored mucus and the eyelids being stuck together in the morning are common with a bacterial infection. White strings of mucus which don’t stick the eyelids together are common with allergic conjunctivitis.

Does my child need allergy testing to see what is causing the allergic reaction?

Not usually since the treatments are generally the same no matter what allergen is causing the reaction. Also, the types of allergens are usually very common things like grass, weed, and tree pollens which are often hard to avoid.

My child takes medications by mouth for allergies. Why aren’t they stopping the allergic reaction in the eyes?

Sometimes the medications taken by mouth are not enough to control the effects of allergies on the eyes. An eye drop in addition to medications by mouth can often help get the eye symptoms under control.

What medication(s) should my child take for his eye allergies?

Both prescription and non-prescription medications are available for the treatment of allergic conjunctivitis. One useful non-prescription medication is artificial tears. Artificial tears work by washing out the allergen from the tear film. Most other non-prescription medications are antihistamines and/or redness relievers. Antihistamines help work against the allergic reaction generated by the body. Redness relievers (also known as vasoconstrictors) shrink the blood vessels on the surface of the eye to help it look less red. Allergy medications containing a redness reliever should not be used for more than a 3-5 days at a time.

Prescription medications often have several different effects on the eye to help alleviate the allergic reaction. Your Pediatric Ophthalmologist can suggest which one(s) would be best for your child.

My child started with a topical anti-allergy drop but is it not helping?

There are different classes of anti-allergy drops with different types of actions. Sometimes what works well for one person’s allergies may not work as well for somebody else. If the symptoms remain the same despite medication; a return trip to your Pediatric Ophthalmologist may be needed for further evaluation. It can be hard to get eye drops into a struggling child’s eyes. Sometimes children will take an oral medication better and get some relief. Cold compresses can help the itching and swelling, but many small children will not tolerate them.

My child’s ophthalmologist prescribed a steroid eye drop for my child. Is this okay?

Sometimes a short course of steroid eye drops along with the anti-histamine type eye drops is required to quiet the allergic reaction.

Why can’t my child use the steroid drop all the time because it works great?

There is a risk of inducing glaucoma in eyes from prolonged steroid usage. It can also cause cataracts with excessive use. Consult your ophthalmologist about how long and frequently a steroid drop may be used because different types of steroids run different risks of creating these unwanted side-effects. A child on steroid drops needs to be monitored for these side effects. It is a bad idea to ask a doctor who is not an ophthalmologist to rewrite a prescription for steroid drops since the monitoring for side effects can only be done by an ophthalmologist.

My eye doctor says that my child’s eyelash dandruff is contributing to his eye allergies. Is that true?

Fig. 2 Allergic Conjunctivitis at the same time every year may be another condition called Vernal Conjunctivitis.  This condition is more stubborn to alleviate and will require treatment from an opthalmologist.

Yes, sometimes this “blepharitis” can contain bacteria which produce byproducts that stimulate a reaction in the eye. Also, if there is a lot of debris in the lashes it can trap allergens such as pollen or mites that are causing the reaction. Therefore eliminating the source through good eyelid/eyelash hygiene is beneficial.

My child seems to get a very serious allergic reaction about the same time every year. He gets lots of big bumps under the eyelid and sometimes next to the colored part of the eye. What is this?

This sounds like Vernal Conjunctivitis which is sometimes more stubborn to alleviate than seasonal allergic conjunctivitis. Some ophthalmologists will use a short course of topic steroid as well as another drop to get it controlled. This type of allergic conjunctivitis can cause a scratch on the cornea of the eye which is painful and needs to be treated by the ophthalmologist [See figure 2].