Allergic diseases are growing in numbers all over the World, and only in the U.S., up to 40% of the population is deemed to be affected by the eye allergies. So, is it a separate disease or a part of the allergic condition of the body (atopy)? Let’s take a look at what is known and published by the gurus in Ophthalmology, Allergy and Dermatology
Facts you should know about eye allergies:
Eye allergy is one disorder, but there are multiple diagnoses
While the symptoms can be the same, the causes are multiple
Allergy is annoying and impacts on the quality of life, but most of the times is not deadly.
Deadly allergic reactions are rare, but almost always the first symptoms start on the face and eyes
While allergic symptoms affect the eyes, the real issue can be in the stomach or… in the earlobe where the metal earing is.
Same eye problem may be called totally different names by different specialists
Most of the eye problems are because of the hands, more precise – because we rub the eyes
Allergy does not affect vision directly, but you would not be able to see if the eyelids are swollen shut? Indeed, the allergy may cause blindness by scarring the eye cornea or causing a cataract
What are the symptoms of eye allergies?
We all know what the red eye looks like. The truth is it could be multiple factors causing an eye problem besides allergy. So, in medicine we call these symptoms non-specific (meaning the same symptoms can cause various diseases).
Here are the most common symptoms of the eye allergy:
Rash on the eyelids
Swelling inside the eye (conjunctivitis) or outside the eye (blepharitis)
Goopy discharge that can act as glue when gets on the eyelashes and eyelids
Skin folds under the eyes
Excessive tearing, tear runs outside of the eyes
Can these symptoms happen with the infection? Yes. What about foreign body? Definitely yes.
How will the doctor find out what exactly caused my eye problem?
It is an interesting question how the doctors can tell infection from the allergy. A young student of the medical school gets overwhelmed by the endless possibility of diagnoses and usually gets the answer wrong. As the study continues, expert professors explain how to find the clues and get a good history with prominent details.
For example, a 5-year-old comes holding the right eye closed. Mom tells the doctor that she picked her son up from a playground after kids started throwing sand. Well, this does not sound like an allergy. Wait, but what if there was a grass around and the child developed an allergic reaction? What if there was a sand in the eye, but someone used a scented wipe to get the sand out. Instead, a reaction to the chemical started? All these things must be considered carefully when a doctor is making a diagnosis. We will review the hints and differences that will help you too when you make a choice whether to go to the urgent care or not.
What are the differences between eye allergies and pink eye?
Here are the suggestive clues to the eye allergy:
There is usually a history of other allergies, such as sneezing, eczema or asthma
Unless there is a first-time reaction, most of the allergic eye symptoms keep coming back after some or complete resolution.
Usually there is a culprit – holding a cat, petting a dog or playing in the grass right before the symptoms started
There are almost always both eyes involved
Symptoms suggestive of the pink eye (infection):
There is usually a history of somebody else having pink eyes at school or in the family
Symptoms start fast, most of the time in one eye with bacterial conjunctivitis.
There are other symptoms of infection (fever, rash, cough) if pink eye is a part of viral illness
What causes eye allergies?
All proteins in our environment, and even food, can cause allergy. So, the same cat that caused asthma, now can be responsible for the eye symptoms.
What is the basic anatomy of the outer eye?
The eyeball is hidden inside the eye socket with only the frontal part visible. It’s surface is covered with conjunctiva which is attached to the eyelid from one side and to cornea on the central part. Cornea is a transparent rounded cover – this is the first part of our optic system that allows the light to get inside the eyeball. Right under the cornea there is an iris – a colored rounded membrane that opens up in the middle with the small rounded pupil that can change size.
Conjunctiva is soft and can stretch to allow for the eyeball movement. It has many blood vessels and can turd red if those tiny capillaries get larger during inflammation.
Cornea does not have blood vessels and is completely transparent looking like a lens. It is extremely sensitive to the dry out, so the tear and oily lubricant is constantly produced by many glands hidden in the eyelids. These glands produce enough tear and oils to prevent eyelids sticking to the cornea or conjunctiva.
Why are the eyes an easy target for allergies?
In general, we should not have allergy as this is an abnormal reaction of the immune system to a normal protein. So, why would it happen? There are lots of theories, and we just do not know for sure. One fact is clear – people had allergy extremely rarely in the times when there was no modern world, chemicals and synthetic plastics.
It may be also connected with the use of antibacterial soaps, cleaning supplies and antibacterial added to food. By killing normal bacteria we ruin our own balance of protection from allergies because we destroy our microbiome. Now, when the immune system is out of balance, any protein that gets in a tight contact with our skin or mucus barriers can cause an “attack” response – allergy.
Our eyes are a good target for entry of any airborne protein, especially if we also rub the eyes and cause micro-trauma.
How are eye allergies diagnosed?
Most of the time it is simple to diagnose the eye allergy even without tests – the history of seasonal allergy (hay fever) or exposure to the animal is enough to get suspicious. An experienced doctor will be able to recognize symptoms of the allergic reaction if you have a red eye, tearing and itching.
Later an allergy test is not a bad idea to establish which allergen is responsible for the eye allergy.
What are allergic eye conditions?
The allergy is a state of the immune system, it is not a disease. Another name for the same situation of hyper-responsive immune reaction is ‘atopy’. To make things more understandable for themselves doctors created many diagnoses – they can reflect just one organ’s problem (allergic rhinitis – runny congested nose due to allergy) or can describe the inflammation in the whole body (hives – systemic reaction to anything that presents as an itch and rash). The symptoms of the allergy that affect the eye have their names too.
Allergic conjunctivitis. This is a condition when inflammation is caused by an allergen that irritates conjunctiva. The inner soft cover of the eyeball that extends to the margin of eyelids swells, becomes red and itchy, the eye tears and has goopy discharge that can get on the eyelids.
Conjunctivitis with atopic dermatitis. When the allergy picks the skin for an attack, a child develops cradle cap, red thick skin in the creases of the arms and legs and the same rash on the eyelids. The diagnosis is called atopic eczema or atopic dermatitis, but if the eye gets involved it is called conjunctivitis
Vernal keratoconjunctivitis. This is a name for an allergic symptom that come with other signs of atopy – allergic rhinitis, asthma and atopic eczema. It is usually caused by the seasonal pollens of the grasses, trees and weeds. The whole body gets affected because of allergic sensitization. The difference here is the whole external surface of the eye gets affected and can significantly affect vision because cornea may develop ulcers and change composition.
Giant papillary conjunctivitis (GPC). This is an inflammation that develop in allergic people who wear contact lenses. It seems there are many factors involved, but the main problem is over-reactive immune cells that are already sensitized to some airborne allergen. So, when a contact lens is also touching the eye structures, it very well may be that the immune cells start attacking it too, just like angry ants will bite anything around if their house was attacked.
What are eyelid allergies (also called contact eye allergies)?
When an allergic war is going on inside the body nothing really gets spared. The eyelids are just a part of the whole organ – skin. No wonder they can get involved in any systemic allergic attack! Meanwhile, the eyelids can also get inflamed due to a very local reaction. For example, a contact eyelid dermatitis can develop with the use of mascara, or as a reaction to artificial nails. Imagine that – a polymer that is used on the nails will cause a severe eyelid problem if you touch and scratch your eye without even thinking about it.
Contact dermatitis can also affect the eyelids in a nickel allergy when a person wears earrings or a neckless. How is it possible? Well, the contact allergy happens within lymph nodes when a tiny molecule of a metal or any chemical gets inside the body through the skin barrier. After a person gets sensitized (which can happen over weeks or months), any body organ can get affected due to systemic reaction.
What conditions can be confused with eye allergies?
One of the most frequent conditions that looks like allergy is an infection. This happens because the inflammation is carried out by the same protective immune cells. Only in one situation it is an allergen (like pollen or a cat hair) and in another – a bacteria or a virus. As in both processes immune cells (lymphocytes) protect your body from intrusion, all symptoms will look similar.
There are also autoimmune diseases that can look very similar – celiac disease frequently presents as an eye allergy or contact dermatitis. So does rheumatoid arthritis.
How are eye allergies treated?
A brief reaction that was caused by a mascara or a new shampoo is easy to treat if you know exactly what caused it. Just stop using it, wash the skin around the face with clear water and use a tea compress. What if that did not help? Sometimes the reaction goes away but later comes back with the vengeance. This time you will probably need to see a doctor who can reassure you that it is just an allergy, and send you to the allergist to figure out what to do next.
Medications. There are plenty of over-the-counter meds that do not require a prescription. You can start with antihistamines. Taking a tablet of Allegra or Zyrtec can eliminate symptoms for a day if that was an allergy. The moisturizing ‘artificial tears’ can help with irritation from a lens wear. Yet, all these are just a symptom eliminating drugs – they do not treat. So, when you stop using them the problem comes right back. Also, if you use antihistamines every day, they will eventually stop working.
If you have been taking medications for more than 2 weeks – it is time to see an allergist to treat the cause.
Allergy shots. Allergy immunotherapy is known for more than 100 years as the most effective treatment. Here the doctor finds out what bothers your immune system by skin test. a prescription that will work for you is unique as it is a mixture of proteins that your immune system considers “enemies”. These proteins are mixed in a solution and administered in micro-doses by shots (allergy shots) or sublingual drops (SLIT) over a period of 3-5 years until the person does not have allergy anymore. Such treatment really addresses the cause of the problem, so is very effective in restoring normal health.
Eye drops. If you need to take care of the eye symptoms, the eyedrops are best as they do not have systemic effects and work fast. There are common issues with eyedrops – difficulty putting them in and burning. It is very difficult to convince a child to use eyedrops, so we do not even recommend to try. It is easier to use oral antihistamine drops for a brief period of time until you solve the primary reason your child is having allergic eyes.
Natural remedies. Natural treatments range from dietary changes to herbs and acupuncture. The main difference between natural treatment and conventional is an approach: natural medicine does not treat a separate symptom, but rather balances the body and makes immune system “behave”.
So, the natural practitioner may choose the herbal treatment, cupping, acupuncture or a special diet to treat allergy. But most likely the treatment will be the same for the eye problem, or runny nose, or rash on the body. Because these are just the symptoms, while the natural medicine treats the whole body.
What is the prognosis of eye allergies?
Eye allergy is not causing any bad side effects unless left untreated. At the same time it impacts the quality of life so much that people who have itchy eyes cannot really function. In addition, there is a psychological disaster as eyes attract the most attention during any personal interaction. After all, red puffy eyes become a disaster on a first day at school or a wedding ceremony. So, if the allergy started the prognosis is – it will not self-cure and needs to be addressed as soon as possible.
Is it possible to prevent eye allergies?
Remember – allergy is not a disease. If you want to avoid all allergies – keep your immune healthy and happy. That means you need to eat healthy organic food, exercise daily, sleep enough hours and get as close to nature as possible. Try to avoid all the chemicals so you will be able to live with all the nature in peace and without allergies.
Avoid the triggers. Well, what if it happened already and your immune system started reacting to the outside proteins? You will need to avoid the triggers at least until you decide to see an allergist who will help you to get back to health.