Allergies cause dry eyes, but dry eyes can also cause itching and watery eyes if you don’t produce enough tears.
An intense itch differentiates eye allergies from the burning, stinging and foreign body sensation associated with dry eye.
If a patient experiences intense itching and redness while outdoors, suspect seasonal allergies. There may be high pollen counts for a specific antigen, depending on the year.
Differentiating between dry eyes allergies (allergic conjunctivitis) and dry-eye syndrome can be a challenging task.
Patients may complain of non-specific symptoms like eye redness and irritation. Catching clinical clues can be difficult if patients are poor historians or can’t recall the situations in which their symptoms are most prominent.
To make matters worse, some patients may have both conditions.
Suppose your eye symptoms develop along with nasal congestion, sneezing, a runny nose, or an itchy throat. In that case, there is a good chance that your eye symptoms are related to allergies.
Dry eyes develop when the quality or quantity of your tears is reduced.
To stay hydrated and moist, the eyes need to constantly produce new tears consisting of lipid, aqueous, and mucin.
What is dry eye syndrome?
Dry eye is an ocular surface disease. What is the leading cause of dry eyes? There is an eye doctor who specializes in the ocular surface disease.
Many reasons for tear film dysfunction include hormone changes, autoimmune disease, inflamed eyelid glands, or allergic eye disease. For some people, the cause of dry eyes is decreased tear production or increased tear evaporation.
Best treatment for dry eye syndrome and dry eyes allergies- Oral TheraLife Eye capsules.
Diagnosing dry eyes allergies – Allergic Conjunctivitis
Allergic disorders of the ocular surface include seasonal allergic conjunctivitis and perennial-
- allergic conjunctivitis,
- vernal keratoconjunctivitis,
- atopic keratoconjunctivitis
- drug-induced dermatoconjunctivitis.
It’s estimated that dry eyes allergies affect one-fifth of the general population.
Seasonal allergic conjunctivitis and perennial allergic conjunctivitis are the most common, prevalent in over 90 percent of allergic disorders.
AKC and VKC are more severe ocular allergies, often having corneal involvement.
Drug-induced allergies tend to affect the area where the drug is instilled (mainly the lower lids) and will generally clear up once the patient stops using the offending agent. We’ll focus here on identifying the more common SAC and PAC.
The dry eyes allergies reaction is an IgE-dependent hypersensitivity response. In susceptible individuals, initial exposure of allergen to the ocular surface stimulates the production of allergen-specific immunologic antibodies (IgE), which bind to mast cells in the conjunctiva.
The mast cell is a granulocyte containing several preformed mediators, primarily histamines. Once activated, newly formed chemical mediators such as prostaglandin D2, leukotrienes, and platelet aggregating factors are synthesized.
Exposure of allergen to the IgE-coated mast cells leads to the release of pre-and newly formed mediators contained within the mast cell.2
In allergy, hyperemia is diffuse in the conjunctival vessels and minimal in the perilimbal and episcleral vessels.
Dry Eyes Allergies symptoms
For dry eyes allergies, histamine is the primary allergic mediator. It’s the only mediator that can reproduce eye allergy symptoms of itching, redness, lid swelling, chemosis, and tearing.
After mast-cell degranulation, histamine binds to receptors located in the conjunctiva.
Binding at H1 and H2 receptors on the vascular endothelium induces dilation and endothelial gaping. In contrast, the binding of histamine to H1 receptors on nerve cells causes itching and some redness and swelling.
Histamine is also the only mediator that, when instilled, produces itching.
Therefore, itchy eyes is the key symptom for identifying eye allergies, which generally produces a strong desire in patients to rub their eyes, creating an itch-rub cycle that can contribute to eyelid swelling. If there’s no itch, it’s not an allergy.
Most patients with dry eyes allergies symptoms will be asymptomatic during their office visits.
The clinician must inquire about environmental triggers such as pet dander, trees, pollen, grass, ragweed, dust, and molds.
Many patients will forget their seasonal allergies in the off-season months.
Only careful questioning may reveal that they have itchy eyes every spring, or their symptoms are heightened when they mow the lawn or visit their cat-owning relative.
They may reveal that their eyes only bother them when they go camping or spend more time outside.
Some patients may take medications during allergy season but won’t report them when asked if they take any drugs.
Occasionally, chart review will reveal that the patient visits the office every May. These are essential clues. The month or season in which the patient experiences symptoms is vital. The intensity and frequency of the symptoms can help differentiate allergic conjunctivitis from dry eye.
Allergy skin testing can often reveal whether or not a patient is allergic to various things. However, it’s important to note that these tests don’t always correlate with site-specific testing (i.e., measuring levels of tear IgE).5 In addition, skin testing may fail to reveal the allergen which provokes allergic conjunctivitis.
IN addition, patients with allergic conjunctivitis symptoms and a positive skin test for a specific allergen may not have a positive conjunctival allergen challenge to that antigen. Thus, a combination of testing and questioning is necessary.
An intense itch differentiates ocular allergies from the burning, stinging and foreign body sensation associated with dry eye. If a patient experiences severe itching and redness outdoors, suspect seasonal ocular allergies.
Depending on the year, there may be high pollen counts for a specific antigen. For example, in the northeastern United States, March is commonly tree pollen season, May is grass season, and mid-August through mid-September is ragweed season. As another example, Sacramento has an exceptionally high incidence of the pan – seasonal allergies.
If a patient experiences intense itching, redness, and discomfort while indoors and during times of the year inconsistent with seasonal allergens, perennial ocular allergies may be involved. Perennial ocular allergens such as dust, pet hair/dander, and mold can present a constant aggravation.
One study of allergens in homes found that the dust collected from nearly all houses sampled contained pet allergens, even though less than half of the homes had pets.6 Thus, it’s difficult to avoid allergens.
Treating dry eyes allergies
Some potential options to treat dry eyes allergies include decongestant eye drops, artificial tears, and oral antihistamines — though these may make symptoms of dry eye worse allergy shots, prescription eye drops, and non-drowsy prescription antihistamines.
Nonsedating oral antihistamines: Prescription antihistamines can be mildly effective in relieving the itching associated with dry eyes allergies.
Over-the-counter antihistamines or antihistamine/vasoconstrictor combinations offer quick onset but a short duration of action. Most are indicated for q.i.d. dosing, but the dose duration is only two to four hours. This regimen, therefore, cannot always provide all-day coverage for ocular allergic signs and symptoms.
Although total avoidance of environmental allergens is nearly impossible, patients can still find relief by reducing their exposure. For instance, staying inside on days with high pollen counts can help decrease symptom severity. However, in most cases, the use of ocular allergic medications is warranted. There are various available products, but the most effective for treating a topical disease such as allergic conjunctivitis are topical ocular treatments that are effective against all signs and symptoms.
Topical treatment of ocular allergies has proven superior to systemic therapy as it ensures direct delivery to the tissue. Additionally, topical treatment avoids the drying effects that have been shown to result from the use of certain systemic antihistamines.7 Ocular drying is counterproductive for treating ocular allergies since a healthy, functioning tear film is vital for flushing away allergens.
The more potent prescription agents with antihistamine and mast-cell stabilizing activity provide the most effective treatment for ocular allergies. This class of dual-action agents includes Patanol (Alcon), Zaditor (Novartis), Elestat (Inspire/ Allergan), and Optivar (MedPointe). These products have comfortable formulations, rapid onset, and a long duration of action (dosed b.i.d.). Patanol is the only eyedrop within this category indicated for the full range of ocular allergic signs and symptoms.
Home remedies for dry eyes allergies
A person could also try natural remedies, such as: massaging the eyes to stimulate tear production using a warm compress on the eyes for dry eyes allergies.
Diagnosing Dry Eye
Patients with a tear-film breakup time of fewer than five seconds can be diagnosed with dry eye.
The underlying cause of dry eye is usually a deficiency in one or more of the three layers of the tear film (lipid, aqueous, and mucin) due to underproduction of tears or excessive tear evaporation. Dry-eye conditions affect an estimated 11 to 22 percent of the population.8 Causative factors in the dry eye include age, gender, systemic medications with drying side effects, dehydration, visual tasking, past surgical procedures, and environmental conditions. Systemic diseases such as Sjögren’s syndrome, rheumatoid arthritis, and lupus are also associated with dry eye. Ocular dryness correlated with meibomian gland dysfunction and blepharitis indicates lipid layer deficient dry eye. In contrast, mucin deficient dry eye is characterized by an underproduction of mucin by the conjunctival goblet cells. Aqueous-deficient dry eye is characterized by a decrease in aqueous production by the lacrimal glands and is usually age-related. Malfunctions in tear secretion can also initiate an inflammatory response on the ocular surface.9
One of the most troubling aspects of dry eye is that symptoms don’t always correlate with signs. Patients may complain bitterly of burning and stinging yet have minimal staining. Other patients may have severe staining yet only mildly complain of photophobia or have no symptoms. Researchers have discovered that dry eye progressively reduces corneal sensitivity, accounting for these findings.10 Therefore, diminishing discomfort scores can be correlated with an increase in ocular-surface disease. This can make the identification and treatment of dry eye a monumental task.
It’s important to distinguish between foreign body sensation (dry eye) and itch (allergy) by asking about the intensity and frequency of the symptoms. Patients with dry eye present with dryness, burning, stinging, grittiness, foreign body sensation, blurred vision, and photophobia. Tearing is another symptom that needs to be elicited explicitly because most people don’t associate it with dry eye. However, many dry-eye subjects will experience reflex tearing due to environmental stimuli, such as wind.
Dyes can aid in diagnosing dry eyes by identifying dry areas of the conjunctiva and cornea. Fluorescein is known to identify disruptions between the corneal epithelium and conjunctival epithelium at intercellular junctions (dry, dead cells). Lissamine green is an alternative dye that is good for identifying degenerated cells and mucus. In studies, typically, only 5 µl of fluorescein or 10 µl of lissamine is instilled.
This administration of micro-quantities of dye is necessary to eliminate the oversaturation of the epithelium, making it easier to distinguish between actual staining and quenching. Time to fluorescence can vary from patient to patient, depending on tear volume and tear turnover rate, but may take two to five minutes. Barrier filters such as Wratten #12 or Tiffen #11 under 16X magnification can help highlight staining.11 A tear-film breakup time shorter than five seconds (with 5 µl of fluorescein) is indicative of dry eye.12 Dye can also be instilled using fluorescein or lissamine green strips.
Blinking is crucial for maintaining the integrity of the tear film. Some of the factors that can influence blink rate are environmental (e.g., humidity, temperature, airflow, and lighting), activity-related (e.g., computer use, reading, and driving), psychological (e.g., emotional state and mental load), and physiological (e.g., gender, ocular surface conditions, corneal sensitivity, and muscular tension). Although researchers have developed a precise method for measuring blink rate that uses a digital camera and infrared illuminator to track pupil diameter (Casavant J et al. IOVS 2004;45: ARVO E-abstract 77), there are other ways to measure blink rate in the office. You can count blinks while a patient is reading the eye chart. Dividing the number of blinks per minute into 60 seconds gives the inter-blink interval (IBI).
Dry eye redness: Horizontal banding over the conjunctiva, limited to the interpalpebral fissure.
The Ocular Protection Index, which measures the relationship between TFBUT and IBI, has recently been developed as an accurate and reproducible tool for diagnosing dry eye. The OPI is calculated by dividing TFBUT by the IBI. If the OPI is less than 1, a patient’s cornea is at risk for environmental exposure since the tear film breaks up before the patient blinks. If the OPI is one or more, a patient’s cornea has reduced risk because the patient is blinking before the tear film breaks up. The OPI is also a valuable tool for evaluating dry-eye treatments. (Ousler GW, et al. IOVS 2002;43:ARVO E-abstract 56)
Treating Dry Eye
Dry-eye treatment usually begins with increased education and a trial of artificial tears. Once patients learn about dry eye, they can modify their behavior to avoid aggravating factors such as environmental stimuli or prolonged visual tasking.
Aside from education and behavior modification, most patients can benefit from artificial-tear therapy. There are several available artificial tears, each with a different mechanism of action. Some examples include Soothe (Alimera), GenTeal (Novartis), Systane (Alcon), and the Refresh products such as Refresh Tears, Liquigel, and Endura (Allergan).
Soothe and Refresh Endura are emulsions that work by enhancing the lipid layer of the tear film. GenTeal, Refresh Tears, and Refresh Liquigel increase the viscosity of the aqueous portion of the tear film and help prevent evaporation. Systane works through a pH-dependent polymerization of HP-guar, creating a gelatinous consistency, which covers and protects the ocular surface. After frequent artificial tear use with no relief, may insert punctal plugs to help retain tears. However, punctal plugs usually reduce the quality of tears by preventing tear turnover. At this point, it may be wise to turn to a prescription dry-eye medication.
Restasis (Allergan) is the only approved medication for increasing tear production due to ocular inflammation associated with dry eye. It is recommended for patients with more severe dry eyes. Research has demonstrated that an artificial tear used in conjunction with Restasis, such as Systane, is a compatible and effective treatment.13 This is especially important before the actual benefits of Restasis kick in, which may be up to six months. There are also numerous products currently in clinical trials that may prove beneficial treatments.
Diagnosis dry eyes allergies
Dry eyes allergies can occur when a person’s immune systems become sensitive and overreact to an environmental situation that usually doesn’t cause problems for most people.
An allergic reaction can happen when this “something” (called an allergen) is in touch with antibodies on the surface of our skin cells; the cell’s response is through histamine release. Eye allergies are common symptoms, as do other eye ailments, so the diagnosis is essential. It can be painful to see and causes inflammation that can impair sight.
Best for Itchy Eyes: ALCON Pataday Once Daily Relief
Pataday contains antihistamine ingredients. Approvable for use in young children under the ages of 2. It’s impossible to reapply until the product wears out and might not work so well as ketotifen. Suppose there has not been any success using ketotifen eye drops. In that case, you might be able to use olopatadine such as Pataday. Pataday’s antihistamine targets irritation from grass, pollen, ragweed, and animal irritants. Dr. Frankese said the product typically is less painful than other ingredients.
Best Budget: Visine Allergy Eye Relief Multi-Action Eye Drops
It helps relieve itching and redness; it works quickly and is reasonably affordable, resulting in a redness rebound. This product may take longer. This company has provided eye health for decades and offers numerous formulations of drops for virtually any eye problem. You may recall that eyedrops are available at an incredibly cheap rate. Because they’re relatively affordable, they provide a wide variety of eye drops for allergies without spending too many dollars.
Natural: Similasan Allergy Eye Relief Drops
Allergy is natural and safe for people with eye problems. These allergy reliever tablets soothe dry eyes, itching, and irritation. It contains natural ingredients that allow use without any issues. It is effective at providing a natural hydration solution in an emergency. The capsule consists of two major botanical extracts to naturally treat your pains.
Best for redness: Bausch & Lomb Opcon-A allergy eye drops
Relieve the itching and redness, Relief the dander and grass allergies Reduce the redness. Redness may cause redness to rebound. Opcon-B may help with the redness caused by allergies by combined with an antihistamine. It is used to reduce inflamed blood vessels to reduce their appearance. This treatment helps relieve itching from grass, pollen, ragweed, and animals.
Best for Dry Eyes: Systane Lubricant Eye Drops
Artificial tears for dry, gritty eyes, long-lasting, for irritable eyes.
Artificial tears can be used whenever needed but cannot treat allergies.
Using antihistamines and decongestants may help relieve the dryness in the skin. Synergy is an excellent solution to make sure the eye stays dry with two different types of glycol.
Bausch + Lomb Alaway Eye Drops provide relief for up to 12 hours.
The best products are researched, tested, and reviewed by independent researchers and are recommended. Medical researchers review article quality to determine if it is medically correct.
Best Overall:Bausch + Lomb Alaway Antihistamine Eye Drops
Generally, this allergy treatment lasts 12 hours and quickly works, but it may sting or burn when applied to the contact. Our top selection was the Bausch + Lomb eye drops because of its 0.025% Ketototenifen antihistamine available for sale.
Antihistamines, including ketotifen, block hepatotoxicity. Alaway is an ideal product for treating allergies to pollen, pet dander, or grass. The device can immediately work with contacts following the instructions in a package. Eye creams that contain no antihistamine, such as Alasmine are safe to be used daily.
Best for contact lens wearers: Refresh Optive Lubricant Eye Drops
Lubricated eye drops can be used in combination with lenses and Relieves irritability, blurriness, and itching Can not be treated with asthma. It is essential to apply frequent contact lenses to people suffering from allergies. These allergy eye drops can also be used with softer contact lenses. In such cases, it helps you to keep the eye moist as contact lenses are one thing that can affect the moisture in the eyes. Ingredients in this product: carbohydrate cellulose sodium 0.5% glycosamine 0.9% | Take a single dose for eye irritation when necessary.
Best for watery eyes:ALCON Zaditor Antihistamine Eye Drops
Quick action and lasting. Originally prescribed strength. Broad-spectrum relief from allergens that can sting and burn when applied. Cannot be used if contact lenses remain on the eye? Do you hate ketotifen and its side effects? Sorry, we also want another! Most people with allergies swear by Zaiditor, which contains the powerful antioxidant Zaiditr, which helps reduce symptoms by lowering blood pressure for up to 12 hours. If there is water in your eye, you should use antihistamines as it helps remove mucus and helps stop it.