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Eye Allergies
Maurice Mosseri, MD is a nationally recognized ophthalmologist
(eye doctor) in New York with offices in Manhattan, Brooklyn, and Queens.
Allergies affecting the eye are fairly common. The most common
eye allergies
are those related to pollen, particularly when the weather is warm and
dry while rain and cooler weather, which decreases the air pollen, often
decreases symptoms. Symptoms can include redness, itching, tearing,
burning, stinging, and watery discharge, although they are not usually
severe enough to require medical attention.
An increasing number of eye allergy cases are related to medications and
contact lens wear. Also, animal hair and certain cosmetics, such as
mascara, face creams, and eyebrow pencil, can cause allergies that affect
the eye. Touching or rubbing eyes after handling nail polish, soaps, or
chemicals may cause an allergic reaction. Some people have sensitivity to
lip gloss and eye makeup.
Eye Allergies FAQ
What exactly are
eye allergies?
The eye and eyelid are a very common site for allergic reactions. About 50
% of conjunctivitis (inflammation of the whites of the eye) seen by
primary physicians is allergic in nature. The eyelid is connected directly
to the covering of the white of the eye called the conjunctiva. Because
the skin of the eyelid is so thin (because it has to stretch) it is
especially prone to minimal irritants, such as cosmetics or even
detergents used on pillowcases. Allergic eye conditions may be
significantly under diagnosed. The symptoms may persist long after the
allergic exposure.
When do allergic
eye symptoms occur?
Allergic eye symptoms may be seasonal, usually in the late spring or fall
when pollen counts are the highest. This is called Vernal Conjunctivitis
(vernal for summer). This is common in persons with allergic rhinitis,
asthma, eczema or hay fever. Up to 80% of hay fever patients may have
allergic eye conditions.
Ocular allergy comes when histamine is released from mast cells. Pollen
and dust come in contact with the mast cells of the conjunctiva producing
what is called a type one hypersensitivity reaction with release of
histamine and other mediators leading to inflammation. The symptoms
include burning, itching, watery discharge that is often thick and is
accompanied by nasal discharge and other allergic symptoms.
What
causes allergy of the eye? Are there different types?
There are many causes and types of ocular allergies. Eczema refers to an
allergic eyelid inflammation, with redness, vesicles, crusts, oozing,
scales, and itching of the lids. Psoriasis and seborrhea dermatitis are
related conditions. Allergic lid edema may be part of a systemic allergic
reaction to drugs, bacteria or parasites, food such as shellfish, or
generalized urticaria or angioneurotic edema. Many patients give a history
of eating shrimp and then the eyes swell. Insect bite, ultra violet
exposure or sunlamp, contact with irritants can lead to severe eyelid
swelling. Because of the thinness and laxity of the skin of the lids, this
swelling may be more extreme than in other parts of the body, but is
usually benign and will respond to appropriate treatment.
Contact dermato-conjunctivitis involves the conjunctiva and the
surrounding skin. It is often secondary to eye drops or cosmetics.
Neomycin-containing preparations are the most commonly implicated
ophthalmic antibiotics. Atropine, local anesthetics, and some glaucoma
medications, are occasional
offenders. Various sprays, colognes, clothing, jewelry, metals, and
plastics, as well as soaps and detergents mat also be offending antigens,
and can be eliminated after careful detective work. There is usually no
family allergic history.
Blepharitis is an inflammation of the eyelid margins, often from a
combination of an infectious agent (bacterial, viral or fungal) and an
allergic reaction to the organism or it's protein deposits. Stapylococcus
aureus or epidermidis are the most frequently involved bacteria. The lid
margins may be scaly and red with dandruff or crusts on the lashes,
Burning, itching, tearing, and light sensitivity are common symptoms. This
is a common condition that can be controlled with local treatment, but
usually not cured, and requires daily treatment including washing and
rinsing.
Vernal conjunctivitis usually occurs in children and is most common in
warm weather. It is often in both eyes and may be recurrent. It is
characterized by severe itching, and a thick mucous discharge, which
contains many allergic cells, called eosinophils. Large papillae may form
on the conjunctiva under the upper lid and white dots or spots may form on
the cornea. Vernal ulcers may be present on the upper part of the cornea.
This comes with the summer weather.
Contact lens conjunctivitis is known as Giant Papillary Conjunctivitis
(GPC) and is quite common. It is believed due to an allergic reaction to
either the contact lens, protein deposits on the lens, or sometimes, the
preservative in the contact lens solution. It is characterized by
increased mucous discharge in the morning, burning and itching, slight
blurring of vision after a few hours wearing time, and progressively
increasing lens intolerance. It is more common in hard contact lens
wearers and least common in those with disposable lenses, especially the
one-day or one week types. Sleeping in contacts greatly increases the
risks of developing GPC.
How are allergies
for the eyes treated?
Although the treatments may vary, the treatment for ocular allergic
problems is the same. The first goal is prevention, as allergies are often
chronic. The second goal is relief of the major symptom of itching, and
the third is the cosmetic relief of the red eye.
First and foremost are appropriate behavioral modifications when
appropriate. Ocular hygiene is also very important. Avoidance of exposure
to offending allergens is critical. This may involve avoiding pets if
sensitive to animal dander, staying inside when the pollen count is high,
eliminating rugs or drapery from the bedroom, frequent vacuuming or the
use of special electrostatic air cleaners. Offending foods, clothing,
makeup, detergents, sprays, or medications should be avoided. Hands should
be washed frequently, and care should be taken to avoid touching the eyes.
Dust proofing the bedroom may be needed. Drive only with windows closed
Close bedroom window because plants pollinate at 5 AM.
Patients with GPC may have to temporarily discontinue their contact lens
wear, change their type of lens or lens solution, reduce their wearing
time, or switch to a daily disposable contact lens for occasional use. The
giant papillae under the lid may persist for months despite these
measures. Ocular medications, such as Cromolyn or Alomide, which prevent
degranulation of the mast cells, preventing histamine release, are often
used in this condition, sometimes for several months. These medications
should not be used while contact lenses are worn. Cold compresses may be
useful in providing initial symptomatic relief, as are artificial tears,
readily available over the counter (OTC) to dilute the allergens. Patients
often try OTC drops first to relieve their symptoms of red, itchy eyes.
While these may be effective, they don't get to the underlying
inflammatory process. The relief is often temporary, and there may be a
rebound effect, with further release of histamine from the mast cell with
continued redness and itching.
More effective prescription medications include mast cell stabilizers,
potent anti-histamines, a non-steroidial anti-inflammatory (NSAID) drops. All of these drops may cause
burning and stinging upon installation. Allergic eye conditions that are
unresponsive to the above or are part of a systemic condition may require
topical or even systemic steriods. Lower strength
steroids can be used, but caution must be taken because of
potential long term steroid side effects, including elevated introcular
pressure and cataracts. Some newer milder steroid eye drops reportedly have
fewer side effects and have increased further our ability to treat
allergic eye disease.
To
schedule an appointment or if you have any surgical or nonsurgical
questions pertaining to your eyes, please feel free to contact the eye
doctor Board
Certified Ophthalmologist, Maurice Mosseri, MD at any of his New York
offices ( Queens, Brooklyn, or Manhattan) or send an email to
info@drmosseri.com. |
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