What is it?

Red itchy watering eyes can often be due to eye allergy. Eye allergy is a abnormal response to any organic or chemical agent present in the air or somehow coming in contact with the eye.

What causes it?

A person can develop allergy to just about any chemical or organic agent. Interestingly there can be allergy to even anti-allergy medicines.

The tendency for allergy is an inherent trait of a person and may have some genetic basis. People who are prone to allergies usually have multiple allergies.

Who are at risk?

Allergy is seen more commonly in children or young adults who have an (hyper)active immune system. People borne of parents who have allergies are at greater risk and so are individuals living or working in environments where they are exposed to chemical fumes or organic dust.

Some specific types of eye allergies are more common in young boys aged 5 to 15 years viz. Vernal Catarrh or Conjunctivitis and some may occur in people who harbor some infections in the body.

What are the symptoms & signs?

Redness, itching & watering are typical symptoms of eye allergy. These symptoms may be accompanied by episodes of sneezing, slight fever, breathlessness or skin allergies. Occurrence of allergy is always preceded by exposure to allergen (the agent causing allergy), so it may be more common in a particular season or a particular environment. In Vernal Conjunctivitis the symptoms are more common in summer months and patient feels better in winter months.

The eyes appear red and may be slightly swollen. Prolonged recurrent allergy can lead to dropping of upper eyelids giving a sleepy appearance. There can be stringy or ropy discharge from the eye and there could be formation of a whitish ring on cornea (black of the eye).

The vision is usually not affected by allergy.

How is it diagnosed?

Eye allergy can be easily diagnosed by its symptoms and a typical history, and by detailed eye examination which reveals the characteristic signs. However, finding out the exact cause or agent giving rise to allergy may not be easy unless an observant patient is able to relate the symptoms to specific agent or one may have to conduct a battery of sensitivity tests with not so rewarding results.

What is the treatment?

The treatment may include some or all of the following depending on the severity of clinical situation:

1. Avoidance of the agent causing allergy or allergen – this is the single most important step in the management of allergy. But identifying and avoiding allergen may not always be possible. In such situations one has to wait for the allergy to die out on it own.
2. Anti-allergic eye drops and sometimes oral anti-allergic tablets.
3. Mast-cell Stabilizing drugs as eye drops are used to prevent recurrence of seasonal allergy
4. Steroid eye drops may be required in severe cases as a short course to control the disease
5. Desensitization is possible in some cases where a specific allergen can be identified and isolated.

What are the surgical options?

Surgery is rarely required for eye allergy. One of the indication for surgery is development of extremely large cauliflower papillae in severe cases of Vernal Conjunctivitis. These giant papillae may require removal / excision by surgery.

What are the outcomes?

Allergy usually dies out naturally over a period of 3-4 years; however, in some cases it may trouble life long. It can be easily controlled with use of appropriate drugs.

What are the complications?

Complications caused by allergy itself are uncommon but are usually caused by the side-effects of the drugs used for its treatment. Prolonged use of steroids as required in very severe cases can lead to development of glaucoma and cataract. Vernal conjunctivitis cases can develop dropping of eyelids (Ptosis) and a ring like opacity in peripheral cornea (Cupid’s Bow).

What is the time course?

In majority of cases the allergy can be easily controlled in 1-2 weeks time. But drug treatment may be required for a few weeks to months to maintain a certain level of comfort. In most cases the allergy lasts 3-4 years.

What is the expense?

The treatment for a given episode of allergy is not expensive. However, recurrent episodes of allergy over the years and especially the management of any of the complications can add up to a significant cost.

The patients of recurrent allergy should work in partnership with the Eye Surgeon to manage their disease.

Author: Dr. Sanjay Dhawan
Updated on: 3 March 2009