Eye allergies: allergic conjunctivitis

Allergic conjunctivitis, also known as “allergic eye disease” affects almost 1 in 5 people. It’s a diagnosis to consider whenever a client presents with itchy, red eyes. The condition in itself is not life threatening, but unpleasant and debilitating if left uncontrolled.

What is allergic conjunctivitis?

Allergic conjunctivitis is an allergic condition caused in the same manner as hayfever. In fact, the majority of your clients with allergic conjunctivitis will also suffer from other allergy-related symptoms.

Allergic eye disease most often causes the person to have itching, red eyes. Clients may also complain about frequent tearing, rubbing of eyes or waking up in the morning with a heavy crust on their eyes. Clients who wear contact lenses may tell you they find their lenses causing discomfort.

The origin of allergies

Allergic eye disease is caused by an abnormal immune system reaction to an otherwise harmless trigger. Essentially the body reacts to something like pollen as if it’s the Ebola virus. This heightened immune system reaction causes swelling, itching, redness and increased secretions in the eye.

People with allergic eye disease tend to have some other related allergic conditions. Most commonly this will be allergic rhinitis (Hayfever) but could also include asthma and skin eczema.

What’s triggering allergies?

There are thousands of allergic triggers which can cause allergic eye disease. InSouth Africa, the commonest culprits include pollens, housedust mite, animal dander and mould. Contact lenses and contact lense cleaning solution can also commonly lead to allergic eye disease.

Some other possible triggers to consider include washing powder and fabric softener (clients will notice symptoms worsen when they sleep at night), duck down, wool, face creams, make-up (particularly mascara or eye liner) and fragrances.

Helping clients find their triggers

Finding the possible trigger and avoiding it if possible is an important step in helping your client manage their condition. Often simply asking a few questions or recommending your client keeps a diary can help detect the cause of their symptoms.

Are their symptoms seasonal or all year around? Pollen allergies tend to worsen in spring and summer and improve in autumn and winter. Allergic eye disease all year around suggests an allergen like housedust mite, animal dander or food as the likely cause.

Are their symptoms worse indoors or outdoors? Pollen allergies tend to cause worse symptoms when the person is outside or on windy days

Is their eye disease triggered when they are around certain animals? Is it worse after petting a certain animal? Cats and dogs can trigger allergic eye disease. If your client notices their eyes itch after being around specific types of animals, then this is a good indicator that this is their trigger.

Is their eye disease worse in the morning or the evening? If their eye disease is worse in the morning, then likely culprits include housedust mite (found in beds and soft furnishings), bedding materials (duck down, wool), cleaning solutions or pets which sleep in the bed. If symptoms are worse as the day progresses then make-up, pollen, contact lenses or work-related irritants are the most likely trigger.

If symptoms have recently started, have they changed any cleaning solutions, make-up or started wearing contact lenses more recently? Often allergic symptoms can be traced back to a specific change of some sort.

Are their symptoms worse inCape TownorJohannesburg? At the coast, housedust mite allergies are worse while inland pollen allergies tend to be more severe.

Testing for allergies

In general, asking your client a few questions can elucidate the cause of their allergies. If not, they can be tested to identify their triggers. Allergy testing is normally reserved for those people whose symptoms are not controlled on standard treatment or avoidance tips or who struggle with very severe symptoms. You can refer your client to an allergy specialist if they want to be tested for their triggers.

There are two main types of allergy testing:

Skin testing: A small amount of the suspected allergen is applied to the skin (usually on the forearm). The skin may be lightly pricked. The doctor will then measure the degree of skin swelling/ reaction to each allergen over the next 10 minutes. The degree of reaction indicates the sensitivity to the allergen. This can usually be done in the doctor’s rooms.

Blood testing: Laboratory tests which check for immune markers to specific allergens (known as CAP RAST testing) can help identify allergic triggers. The doctor will need to narrow down the likely suspects before testing, otherwise this can be an expensive exercise. The results are normally available within a few days.

Taking the itch out of their eyes

If you can help your client identify their allergic trigger, then lifestyle changes may be all that is required to get their symptoms under control.

While some allergic triggers are avoidable (e.g. contact lenses, make-up) others are more difficult to control (e.g. pollen, housedust mite).

Here are some recommendations you can make to your clients:

Pollen allergies:

• Avoid mowing the lawn
• Keep house windows and doors closed on windy days
• Don’t exercise outdoors during pollen season (September to March)
• Wipe a bit of petroleum jelly to your lower nasal passages – it will help trap some of the pollen before it gets into your nose.

Housedust mite

• Clean all soft furnishings, curtains, carpets and bedding regularly
• Avoid carpets in the house

Animal dander

• Wash pets regularly
• Wash hands after petting animals
• Keep pets out of the bedroom
• Clean furnishings regularly which could hold shed animal hair and skin

Contact lenses

• Find a contact lense solution which effectively removes all debris and particles
• If using disposable contact lenses, don’t wear them longer than the recommended period
• Don’t wear contact lenses more than 8 hours each day
• Have a contact lense free day every week
• Don’t wear contact lenses while their eyes are red or itchy

Managing the itchy eye

Cold or hot compresses: Advise your client to apply a clean wet facecloth over the eyes and press gently. Keeping their eyes closed and applying a wet cloth can sometimes soothe allergies and help them avoid scratching.

Don’t rub: The more they rub their eyes, the itchier they become. Also known as the “scratch-itch-cycle”. While the temptation to rub can be overwhelming, advise clients to clean their face, remove any contact lenses and try to avoid scratching.

Clean eyes gently of exudates in the morning: Clients will most often rub their eyes of grit first thing in the morning. This is often all it takes to set off the cycle. Advise them to wash their face in warm water and gently wipe away any grit.

Medical intervention

Antihistamines: You can recommend an antihistamine to help control symptoms. Recommend to your client that they use medications at night time as most lead to drowsiness. There are literally hundreds of antihistamines so help clients find one which works for them. Some examples which are available without a script include promethazine (e.g. Phenergan, Lenazine), chlorphenamine (e.g. Allergex, Rhineton), Cetirazine (e.g. Zyrtec, Texa, Zetop) and desloratadine (e.g. Deselex).

Antiallergy eye drops: You can recommend anti-allergy eye drops such as Relestat, Allergex, Patanol,  Relestat, Stop-Allerg and Vividrin all of which can help soothe irritated red eyes. Most of these eye drops can be applied up to 3 or 4 times a day to help ease allergic symptoms.

Steroid eye drops: Steroid eye drops can help ease allergic symptom where simpler anti-allergy eye drops aren’t helping. Steroid eye drops are only available with a doctor’s prescription, purely because they can cause more harm than good if used where there is an eye infection. Steroid eye drops such as bethamethasone (e.g. Betnesol, Spersadex 0.1%), dexamethasone (e.g. Dexagel, Maxidex), fluoromethalone (e.g. Efemoline, Fucon, FML) and prednisone (e.g. Pred-Mild) can all be used to control allergic conjunctivitis symptoms.

Helping your clients

Allergic eye disease will be a problem which you are frequently asked to assist with. Often the solution lies in helping your clients recognize their trigger and learn to avoid it. Make sure you know which over-the-counter eye drops and antihistamines can help control their symptoms. It can make a world of difference to your clients.

For more information on allergic conditions you can direct your clients to the Allergy Society of South Africa’s website on www.allergysa.org.