Itchy Eyes: It’s important to distinguish the cause

By Dr. Jean E. Keamy

Once April flowers begin to bloom, many patients complain of itchy eyes.

For some the symptoms last until the leaves fall off the trees. For others, their eyes itch with the bloom of certain trees, flowers or mold. Seasonal allergies are the number one reason eyes itch. Many complain of associate symptoms: nasal congestion, sore throat, cough and sinus headaches. Itchy eyes can be the only symptom of seasonal allergies.

What distinguishes allergic conjunctivitis from other causes is the lack of purulent discharge, swollen lymph nodes, chills or fever. Also, with allergic conjunctivitis, the eyeballs, not just the lids, itch. With allergic conjunctivitis, the eyes might become red, swollen and water; however, itching is the dominant complaint.

When the eyes itch, the worst thing to do is to rub the eyes. Rubbing the eyes helps release more histamine. This leads to more itching. Cool compresses can help.

Over the counter systemic antihistamine oral medications can provide relief. First line, over the counter eye drop therapy, usually involves vasoconstrictors and then antihistamine eye drops. Preservative artificial drops can also wash away some of the allergens to reduce the itching.

If symptoms do not improve with over the counter medications, I recommend an examination with your ophthalmologist. It is important also to have an eye exam to distinguish allergic conjunctivitis from viral conjunctivitis and blepharitis of the eyelids. Your eye doctor can prescribe more effective medication. For example, prescription antihistamine, mast cell stabilizers, non-steroidal anti-inflammatory or low dose steroid eye drops can often provide relief within a few days. Your ophthalmologist will determine which eye medication will work best for you.