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Different Types of Eye Allergic Conditions

Almost half of the people with different types of allergies have eye allergies. An eye is the most vulnerable part of the body, and any kind of discomfort in the area has all chances to ruin your day (or days). Allergic eye symptoms are a common reason for visiting the ophthalmologist or allergist, as severe eye allergies cause serious damage that can threaten eyesight.

Eye allergies mainly involve the conjunctiva. Conjunctiva is the tissue lining that covers the white surface of the eyeball and the inner folds of the eyelids; it is full of mast cells (more than even in lungs) and is rich in blood vessels. Actually, it is a barrier between inner structure of the eye and the environment.

The lacrimal glands (those that produce the watery component of tears) are located in the upper and outer portions of the eye. Tears wash away all the substances from conjunctiva and moist it.

The tears also contain important immune defense substances such as immunoglobulin, enzymes and lymphocytes.  

How is it going? When you open your eyes, the conjunctiva becomes directly exposed to the environment without the help of any protection of filtering system (such as little hairs are in the nose). Then some generally harmless substance that you are allergic to (or viruses and bacteria) gets into contact to your wide open conjunctiva. Allergen causes the allergy antibody (IgE) to coat numerous mast cells in the conjunctiva. They release histamine and other mediators. These mediators are responsible for the symptoms of allergic reactions. The inflammation causes enlargement of the blood vessels in the conjunctiva ("congestion"), resulting in a red, or blood- shot appearance of the eyes. Watery eyes, itching and burning comes as a result as well. In addition to it the eyelids may swell (very often to the point of closing), or the conjunctiva may swell with fluid and protrude from the surface of the eye. Generally, both eyes are affected by an allergic reaction. It is accompanied with other symptoms that may either get worse or may not be changed.

Eye allergy (or allergic conjunctivitis) is inflammation of the conjunctiva that is caused by a reaction to allergens. This is an overreaction of the immune system to foreign substances, which might be harmless (but not necessarily). Allergic conjunctivitis is divided into several types depending on the nature of the allergen.

Seasonal allergic conjunctivitis

This type is also called Hay fever conjunctivitis. This is a sudden intense response to usually an airborne allergen. This allergy is episodic and occurs only certain part of the year, particular season of a year (it explains the name of the type). During the summer season, it is caused due the exposure to grass and different types of tree pollen. In the fall, it is caused mainly due to the exposure to weed pollen. Seasonal allergic conjunctivitis affects up to 25 per cent of the general population. The hay fever includes also nasal symptoms.

Vernal (spring) conjunctivitis

This type of eye allergy is also seasonally recurring conjunctivitis which can also affect the peripheral cornea. It occurs generally in children and young adults. To be more specific - in preadolescent boys (3:1 male to female ratio). Vernal keratoconjunctivitis usually appears in the late spring and particularly occurs in rural areas where dry, windy, dusty, and warm conditions prevail. The symptoms are typical (red watery eyes), plus eyes become sticky due to a discharge and are quite hard (and painful) to open. The pain intensifies when opening the eyes after sleeping. The inner membranes of the eyelids swell and conjunctiva has change in appearance (develops a “cobblestone look”). Vernal conjunctivitis should be treated immediately. Improper treatment can lead to permanent visual impairment.

Atopic keratoconjunctivitis

Atopic keratoconjunctivitis is similar to vernal keratoconjunctivitis. Only difference is that it but occurs mainly in older patients who have had a history of atopic eczematoid dermatitis, but may occur in young adults as well, especially in those who had atopic dermatitis in early childhood. The triggers for atopic keratoconjunctivitis appear to be similar to those of atopic dermatitis, food allergy and airborne allergens (particularly dust mites and dander).

This type is also called “conjunctivitis with atopic dermatitis”, “atopic keratoconjunctivitis” or is called “eczema eyes”, it is not seasonal. The symptoms are usual - itching and dry eyes, which is followed by blurred vision; in case of severe allergy - the eyes become sensitive to light and the eyelids noticeably thicken. It requires treatment, as it can cause more extensive corneal and conjunctival scarring. This scarring can cause visual changes. In 10% of cases it can lead to cataract formation, in rare cases – may lead to the blindness.

Perennial allergic conjunctivitis

Perennial allergic conjunctivitis can be caused by both indoor and outdoor allergens. This type occurs throughout the year (mainly in spring or fall); very often it may get worse during these seasons. In spring the common allergens are mold and grass, but appear most commonly in the fall (dust mites and fungal allergens). All over the year allergy may be caused with house dust mite and cat allergies. The symptoms are usually milder than those in seasonal allergic conjunctivitis - eyes become mildly itchy, watery and red.

Contact lens allergy and Giant papillary conjunctivitis

One type of eye allergy is called “contact lens allergy” or “contact allergic conjunctivitis”. A more severe form “giant papillary conjunctivitis” – is large swellings of the mucous membranes of the upper lid that may result ultimately in the inability to wear lenses. Allergy to contact lenses is most common among wearers of hard contact lenses, and is least common among those who use disposable lenses (especially the one-day or one-week types). Constant local irritation by the contact lenses on the conjunctival surfaces develops giant papillary conjunctivitis.

This type of eye allergy is named for its typical feature - large papillae (or bumps) on the conjunctiva under the upper eyelid. This condition is believed to be due to an allergic reaction to either the contact lens itself, protein deposits on the contact lens (the proteins in tear film that bind to the surface of the lens), or the preservative in the solution for the contact lenses.

Common symptoms are redness, itching of the eye, mucous discharge, and lens discomfort.

Medication reactions and Toxic papillary reactions

This is a sudden, intense reaction which often includes conjunctival swelling and an intense itching. That is an allergy that is caused by the intake of certain medicines. Common offenders include topical penicillin, anesthetics, bacitracin, and sulfacetamide.

Toxic (or irritative) papillary reaction is an eye allergy that can occur anytime after one week of medication use, and are due to some antibiotic and antiviral drops, as well as certain preservatives.

Contact eye allergies

Other name of this type is eyelid allergy – an allergic inflammation of the eyelid from direct contact with certain allergens. Contact eye allergies are essentially contact dermatitis of the eyelids. The triggers are following:

  • allergic reactions to preservatives in eye products and cosmetics in women (e.g., eye creams, eye pencils, mascara, and nail polish - from rubbing the eye with the fingers)
  • allergic reactions to OTC ointments such as Neosporin or Bacitracin
  • allergic reactions to contact lens solutions (especially if they contain thimerosal)

Symptoms are similar to those of poison ivy rash - the eyelids may develop blisters, itching, and redness, the conjunctiva may also become red and watery. The lids may become chronically (long-term) inflamed and thickened.

In addition it is necessary to note, that some conditions can be confused with eye allergies:

  1.   Dry eye - results from reduced tear production. The symptoms are usually burning, grittiness, or the sensation of “something in the eye”. It occurs usually in old people over 65 years of age and can be worsened by oral antihistamines, sedatives, and b-blocker medicines
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  3.   Tear duct obstruction – the condition that is caused by a blockage in the tear passage that extends from the eyes to the nasal cavity. It occurs usually in old people as well. The main symptom is watery eyes that do not itch.
  4.   Conjunctivitis due to infection - caused by either bacteria or viruses. Common symptoms in case of bacterial infections are "dirty eyes" - discolored mucous discharge, and "bright red eyes" - the eyelids stick together, especially in the morning. In case of viral conjunctivitis - slight redness of the eyes and a glassy appearance from tearing

All these conditions are not eye allergies. They usually give negative result in allergy testing and require different treatment.

Valentyna Ant.


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