ALLERGIC CONJUNCTIVITISOphthalmologist Carolina Valdivia, MD responds to a question about allergic conjunctivitis from a reader in Bangladesh.  A male reader from Bangladesh writes:Hi Doc. My eyes always are a red color. They constantly irritate me, water a lot, and the white part darkens. My doctor tells me that it is an allergic problem. But it has been one year and the problem still is not solved. He has recommended histasin, alatrol (cetirizine) and vitamins. Can you suggest anything else?
Your eyeball and the inside of your eyelids are covered by a clear, thin membrane called the conjunctiva. If something irritates this covering, your eyes may become red and swollen. They also may be painful, itch or water. This is called conjunctivitis or pink eye. Common causes of pink eye include bacteria, viruses or allergens. An allergen is a substance that, in some people, the immune system recognizes as foreign or dangerous and attempts to mount a response against it. For example, dust-mite feces and pollen are common allergens, but the list of known allergens is long. Environmental irritants also can cause allergic pink eye.Allergic conjunctivitis in some patients can be constant, with only short periods in which pink eye symptoms are alleviated but do not disappear completely. It can be caused by any number of allergens. There are some steps that you can take to help alleviate your allergic pink eye. I recommend that you limit your exposure to house dust as much as possible. Keep the place where you sleep very clean. Change your bedding frequently. Avoid touching animals. When you go out, protect your eyes with sunglasses that have a strong UV filter. Using a cap or hat with a brim also can help, especially with the darkening you experiencing in your conjunctiva, a symptom associated with allergies. While outside, avoid situations where your eyes are exposed to dust or wind. Because of the itching, burning and other feelings of discomfort, patients with allergic conjunctivitis frequently rub their eyes. This can further exacerbate inflammation and reddening of the conjunctiva. It also can introduce bacteria. Once bacteria infect the conjunctiva the situation becomes more serious. Therefore, it is advisable to wash your hands frequently when you have allergic pink eye and avoid touching or rubbing your eyes as much as possible. I also recommend that you keep a written diary of when your pink eye symptoms are the most extreme. At what time of the day does this occur? Where are you? What are your surroundings? What are you doing? If your pink eye symptoms are extreme most of the time, then instead keep a record of when they subside to some extent. This will assist your doctor in identifying the underlying causes of your allergic conjunctivitis. In addition to seeing an ophthalmologist, you might also consider visiting a medical specialist in allergic diseases. She or he can perform a series of tests that will help in identifying allergens to which you are particularly sensitive. This information will assist in developing a specific pink eye treatment plan, one that potentially can offer significant long-term improvement, as opposed to a mere control of pink eye symptoms. Make sure that you bring the record you have been keeping that documents when your worst pink eye symptoms occur.
DOES ALLERGIC CONJUNCTIVITIS DAMAGE EYESIGHT?In most cases it does not. Although allergic pink eye is irritating and uncomfortable, it rarely affects eyesight.
SHOULD I STOP WEARING MY CONTACT LENSES?Yes. Wearing contact lenses can cause your allergic pink eye to become worse. Instead, it is better to wear glasses until your eyes feel better.
HOW IS ALLERGIC CONJUNCTIVITIS TREATED?Placing a cold washcloth over your eyes can provide temporary relief. Additionally, there are several types of allergy medications that can be applied directly to the eyes and provide temporary relief from inflammation of the conjunctiva. Lubricating eye drops (sometimes called artificial tears) may also make your eyes feel better, but do not help with the underlying cause of conjunctiva inflammation. It is important not to overuse these. Several other types of eye drops are available for pink eye treatment. They can help relieve itchy, watery eyes and may keep symptoms from returning. Eye drops may contain an antihistamine, a decongestant, a nonsteroidal anti-inflammatory drug (NSAID) or a mast-cell stabilizer. Some drops contain a combination of these. Some eye drops require a prescription. Talk to your doctor about which pink eye treatment is right for you. Responses to allergy medicines can vary. A medication that works really well for one person may not work at all for someone else. Additionally, the effectiveness of medications that initially work for you can diminish over time. Doctors often rotate medicines to help avoid this problem. For this reason, it is important that you explore options for ongoing pink eye treatment in consultation with an ophthalmologist. that you trust. One solution might be to use a medicine that provides good control during regular periods and a second one to be added if your pink eye symptoms become extreme.
DOES PINK EYE TREATMENT HAVE SIDE EFFECTS?Eye drops can cause burning and stinging when you first put them in, but this usually subsides after a few minutes. Be aware that all medicines potentially can cause side effects. For this reason, it is important to consult with your doctor before using any medicine, including eye drops and other forms of pink eye treatment. I cannot recommend specific medications for allergic pink eye. It would be irresponsible for me to do so without first examining you and understanding your case in detail. However, I strongly urge you to be examined both by an allergist and an ophthalmologist in your area.
CAN GLAUCOMA CAUSE SYMPTOMS SIMILAR TO ALLERGIC CONJUNCTIVITIS?Yes and no. Certain types of glaucoma can cause eye redness. One of these is neovascular glaucoma. However, this typically is associated with other chronic conditions, such as high blood pressure, diabetes, and elevated blood cholesterol. Another type is the acute form of primary angle-closure glaucoma. But this is a condition that usually occurs in people 40 years of age or older and is accompanied by severe pain. Acute angle-closure glaucoma always is serious and constitutes a medical emergency. If left untreated or if treatment is delayed, it can lead to grave complications in the affected eye. Glaucoma is a serious chronic disease of the eye that if left untreated can lead to blindness. In other words, it can cause serious damage to the eye. On the other hand, allergic conjunctivitis most often is a transient condition that causes discomfort and irritation to the eye, but does not result in serious eye damage. Carolina Valdivia, MD
REFERENCES:Friedlaender MH. A review of the causes and treatment of bacterial and allergic conjunctivitis. Clinical Therapeutics. 1995;17(5):800-810. Khurana AK. Comprehensive Ophthalmology, 4th Ed. New Delhi: New Age International (P) Limited Publishers, 2007: 51-88. Wong AH, Barg SS, Leung AK. Seasonal and perennial allergic conjunctivitis. Recent Patents on Inflammation and Allergy Drug Discovery. 2009;3(2):118-127.
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Return from Allergic Conjunctivitis to Answer My Health Question
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As you describe it, your problem is chronic, meaning that you have been living with it for a long time. Your symptoms suggest that you are suffering from an allergic process, as your doctor has diagnosed.
Antihistamine pills, such as the histasin and cetirzine (Alatrol, Zyrtec) that your doctor has recommended, can also help relieve pink eye symptoms associated with allergic conjunctivitis.