Allergic Eye Disease (Allergic Conjunctivitis)

Allergic eye disease is inflammation of the surface of the eye caused by an allergic reaction. The common forms are seasonal and perennial allergic conjunctivitis, which are uncomfortable but harmless to sight. The uncommon forms, vernal keratoconjunctivitis in children and atopic keratoconjunctivitis in adults with eczema, can damage the cornea and threaten vision. Contact lens wearers can develop giant papillary conjunctivitis.

Itching is the hallmark. Treatment with allergen avoidance and antihistamine or mast cell stabiliser drops controls most cases. Severe forms need an ophthalmologist, because the steroid drops that work well can cause glaucoma and cataract if used without supervision.

Symptoms

• Itchy eyes, often intense, with an urge to rub
• Redness and watering in both eyes
• Puffy eyelids, particularly in the morning
• Stringy, clear or white mucus
• Sneezing and a runny or blocked nose at the same time
• A gritty feeling or the sense that a contact lens no longer sits comfortably
• Light sensitivity, pain or blurred vision, which suggest the cornea is involved

Causes and risk factors

In sensitised people, allergens landing on the eye trigger mast cells in the conjunctiva to release histamine. Seasonal disease is caused by tree, grass and weed pollens; perennial disease by house dust mite, animal dander and moulds. Vernal keratoconjunctivitis mostly affects boys in warm, dry climates, flares in spring and summer and generally burns out after puberty. Atopic keratoconjunctivitis accompanies long-standing eczema and asthma. Giant papillary conjunctivitis is a reaction to deposits on contact lenses, ocular prostheses or exposed stitches. Preservatives in eye drops and cosmetics can cause a contact allergy of the lids.

How it is diagnosed

• History and slit lamp examination: The pattern of itching, seasonality and associated hay fever, eczema or asthma, plus examination of the conjunctiva under the upper lid for papillae, usually gives the diagnosis.
• Fluorescein staining: A dye shows corneal surface damage or a shield ulcer in severe vernal or atopic disease.
• Allergy testing: Skin prick or specific IgE blood tests identify triggers when avoidance or immunotherapy is being considered.
• Excluding other causes: Dry eye, blepharitis and viral or bacterial conjunctivitis can look similar, and burning rather than itching points towards them.

Treatment options

• Avoidance and simple measures: Cold compresses, preservative-free artificial tears to wash out allergens, wraparound sunglasses, washing hair before bed in the pollen season, and not rubbing the eyes.
• Dual-action antihistamine and mast cell stabiliser drops: Olopatadine or ketotifen once or twice daily are the mainstay. Mast cell stabilisers alone, such as sodium cromoglicate, work best when started before the season.
• Oral antihistamines: Helpful when the nose is affected too, though they can dry the eyes.
• Short courses of steroid drops: For severe flares, prescribed and monitored by an ophthalmologist with eye pressure checks.
• Ciclosporin or tacrolimus: Steroid-sparing drops or ointment for vernal and atopic keratoconjunctivitis that need long-term control.
• Contact lens changes and immunotherapy: Switching to daily disposable lenses or taking a break from lenses for giant papillary conjunctivitis, and allergen immunotherapy for troublesome pollen or dust mite allergy.

When it is urgent

See an eye doctor the same day near where you are if you have eye pain, marked sensitivity to light, reduced vision, a white spot on the cornea, or one red eye in a contact lens wearer, as these suggest corneal ulceration or infection rather than simple allergy. Swelling of the lips, tongue or throat or difficulty breathing alongside eye symptoms is a medical emergency.

Travelling to Türkiye for treatment

Allergic eye disease is a recurring condition best managed by a local optician, general practitioner or ophthalmologist, and it is not a reason in itself to travel. If you are visiting for other eye care, an assessment can confirm the diagnosis, check the cornea and set out a treatment plan. People with keratoconus associated with years of eye rubbing, or planning laser vision correction, should have the allergy under control first. Allergen immunotherapy runs for about 3 years and needs to be given at home.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

Frequently Asked Questions