Spring eye allergies: symptoms, treatment and when to seek help

Spring pollen can trigger allergic conjunctivitis, causing itchy, red and watery eyes. Symptoms may be mild and occasional, or sufficiently persistent and severe to interfere with vision, contact-lens wear, work and sleep.

Appropriate treatment depends on the severity of the inflammation and whether allergy is the only cause of the symptoms.

What is allergic conjunctivitis?

The conjunctiva is the thin membrane covering the white of the eye and lining the inner surface of the eyelids. Allergic conjunctivitis occurs when this tissue becomes inflamed following exposure to an allergen.

Common symptoms include:

• Itching, which is often the most prominent symptom

• Redness

• Excessive watering or clear discharge

• Swollen eyelids

• Burning, irritation or a gritty sensation

Both eyes are usually affected, although one may be worse. Eye symptoms often occur with hay fever, including sneezing, nasal itching and a runny or blocked nose.

Because allergic conjunctivitis is an allergic reaction rather than an infection, it is not contagious.

What causes eye allergies?

Pollen from grasses, trees and weeds is a common cause of seasonal allergic conjunctivitis. Symptoms may be worse on hot, dry or windy days when more pollen is airborne.

Other triggers include:

• Dust mites

• Mould spores

• Animal dander

• Cosmetics and skincare products

• Contact lenses or contact-lens solutions

• Preservatives or active ingredients in some eye drops

Exposure to indoor allergens can cause symptoms throughout the year rather than only during spring.

Treating mild eye-allergy symptoms

Reducing exposure to a known allergen is an important part of treatment. Practical measures include:

• Wearing close-fitting sunglasses outdoors to reduce pollen exposure

• Applying a clean cold compress over the closed eyelids

• Using lubricating eye drops to soothe the ocular surface and help wash away allergens

• Avoiding rubbing the eyes

• Washing the face and hair and changing clothes after substantial pollen exposure

Contact lenses should be removed if the eyes become red, sore or significantly irritated. They should not be worn again until the symptoms have settled and it is safe to resume use.

Allergy eye drops

Antihistamine eye drops can provide relatively rapid relief from itching. Mast-cell stabilising drops are used regularly to reduce the allergic response and are more effective when commenced before or early in the allergy season. Some products combine both actions.

The appropriate drop depends on the diagnosis, severity of symptoms, contact-lens use and other eye conditions. A pharmacist, optometrist, general practitioner or ophthalmologist can advise which non-prescription or prescription treatment is suitable.

Antibiotic eye drops do not treat allergic conjunctivitis.

Steroid eye drops may be required for severe inflammation, but they must only be used under appropriate medical supervision. Incorrect or prolonged use can increase eye pressure, contribute to cataract formation and worsen or mask an eye infection. Old steroid drops should never be restarted without examination and medical advice.

Chronic or severe allergic eye inflammation

Allergic eye disease is not always a minor seasonal problem. Persistent or severe inflammation can cause substantial discomfort, recurrent redness, marked eyelid swelling, mucus discharge and difficulty tolerating light.

More severe forms of allergic eye disease can affect the cornea, the clear front surface of the eye. These include vernal keratoconjunctivitis, which occurs more commonly in children and younger people, and atopic keratoconjunctivitis, which is often associated with eczema. Corneal involvement can affect vision and requires ophthalmic assessment and treatment.

An examination is also appropriate when symptoms repeatedly return, remain predominantly in one eye or fail to respond to appropriate allergy treatment. Dry eye, blepharitis, medication reactions, infection and other eye conditions can produce overlapping symptoms and may coexist with allergy.

When to seek urgent assessment

Do not assume that every red, watery or uncomfortable eye is caused by allergy. Seek prompt eye or medical assessment for:

• Eye pain

• Marked sensitivity to light

• Blurred or reduced vision

• A large amount of thick or coloured discharge

• Severe swelling or difficulty opening the eye

• Symptoms following an eye injury or chemical exposure

• A painful or significantly red eye in a contact-lens wearer

These features may indicate corneal disease, infection or another condition requiring urgent treatment.

Eye & Retina Specialists Sydney in Green Square/Waterloo assesses persistent, severe and atypical eye irritation when specialist review is appropriate.