Allergic Conjunctivitis

Redness, tearing, itching, or irritation of the eyes are common; many think these symptoms are due to dust or dirt particles getting into and irritating the eyes, leading to conjunctival inflammation and pink eyes. However, allergic rhinitis can also present with similar symptoms. Red, teary, itchy, and irritated eyes can also be symptoms of allergic conjunctivitis. If a patient receives treatment for an eye infection only, the symptoms may not improve.

Allergic conjunctivitis

Allergic conjunctivitis is inflammation of the conjunctiva -- the clear lining of the sclera and inner eyelids -- caused by over activation of the immune system elements against aeroallergens in the eyes, leading to chronic conjunctival inflammation. It is common in allergic rhinitis patients. patients.

Contributing factors

• Wearing contact lenses
• Dry eyes
• Glaucoma
• Meibomian gland inflammation
• Eye diseases requiring daily use of eye drops

Is allergic conjunctivitis more common in adults or children?

Allergic episcleritis can affect children and adults ranging from 2 to 60 years of age. Patients with allergic conjunctivitis often have a parent with atopy. 

Symptoms

Patients have red, teary, itchy, or irritated eyes with clear or cloudy white discharge. The symptoms typically involve both eyes, but the eyelids and vision are unaffected. Patients can have concurrent allergic rhinitis symptoms, including nasal itching, sneezing, congestion, and rhinorrhea. These symptoms are chronic and flare up in the evening or at dawn. If intercurrent conjunctival bacterial infection supervenes, patients will experience a burning sensation in the eyes. Tear appearance changes from clear to purulent discharge, accompanied by eyelids inflammation. Symptom severity varies, ranging from mild to severe, causing annoyance and interfering with daily activities.

Treatment

• Oral antihistamines can reduce sneezing and soothe itchy and runny nose or itchy eyes. The current formulation of antihistamines allows once-a-day dosing without daytime sleepiness. They come in pill and syrup forms, conveniently tailored to suit children in different age groups.
• Antihistamine eye drops are prescribed if oral antihistamines cannot control the symptoms. Patients should apply eye drops 2-4 times a day. Once opened, their shelf life is one month, and they should be stored in the refrigerator to maintain potency. Applying cold eye drops can help relieve eye symptoms. Efficacious allergic rhinitis treatment can relieve allergic conjunctivitis symptoms without needing antihistamine eye drops.
  
  

  How to apply antihistamine eye drops to children

1. 1. Ask your child to tilt the head back slightly. Pull down on the lower eyelid while asking the child to look up, and then instill the eye drops. Be careful not to let the tip of the eye drop nozzle touch any part of the eye.
   2. Ask the child to close his/her eyes for 1-2 minutes while gently pressing on the inner corner of the eyelids with a fingertip to prevent the eye drop from draining into the nasal cavity. Do not massage or rub the eyes after eye drop instillation.

• Use artificial tears to flush out allergens, which can help moisten the eyes aside from rinsing out the allergens or irritants in the eyes. 
• Use of cold compress to relieve swelling can help alleviate the itching and swelling of the conjunctiva.

Summary 

Allergic conjunctivitis often accompanies allergic rhinitis. Maintaining good control of allergic rhinitis can improve allergic conjunctivitis. If allergic conjunctivitis is severe, ophthalmic steroid eye drops may be necessary. However, their use should be under the supervision of an ophthalmologist to monitor for untoward side effects such as cataracts or glaucoma.