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Allergic Eye Disease

What is allergic eye disease?

Allergic eye disease (also known as allergic conjunctivitis) is an allergic reaction in the eyes. Symptoms occur when someone is exposed to environmental allergens like house dust mite, pollen and pet dander to name but a few culprits. 

Seasonal allergic conjunctivitis: Many people are affected by allergic conjunctivitis seasonally with pollen from tree’s, grass and weeds being the trigger and symptoms that effect the eyes may be are part of their hay fever. Pollens land on the surface of the eye and trigger the release of substances such as histamine.

Perennial allergic conjunctivitis (all year round) is caused in the same way, but is usually a reaction to house dust mite or pets in the indoor environment, rather than to seasonal pollens.

The main symptoms of allergic eye disease are:

  • Itching
  • Burning
  • Watering (clear discharge)
  • Redness in both eyes
  • Swelling of the eyelids
  • Visual problems (discomfort to bright light)

It should be noted that conjunctivitis is caused by an inflammation of the conjunctiva of the eye and can be caused but other sources aside from allergy including, infection, bacteria, viruses, and physical or chemical irritants. If you are unsure if your eye symptoms are related to your allergy do not delay in seeing a healthcare professional to ensure you get the right diagnosis and treatment.

Management of allergic eye disease

The first consideration is allergen avoidance, but before allergens can be avoided they must be identified. Sometimes the trigger is obvious e.g. someone with hay fever experiencing symptoms whilst walking through a grass field on a warm summer day, other times the cause is not as clear cut. Many allergic people react to common allergens, which are, by definition, difficult to avoid. For more details on avoiding allergens, see our Factsheets Allergic Rhinitis and Hay Fever and Indoor Air Quality.

  • Anti-histamine eye drops or oral anti-histamines might suit patients better whose eye symptoms coincide with other symptoms of hay fever. Long acting, non-sedating oral antihistamines are recommended for regular use.
  • Mast cell stabilisers have been used in eye drop form for many years. The effectiveness and excellent safety record of this has earned it ‘gold standard’ status in the management of allergic eye disease.
  • Steroid eye preparations are very effective in allergic eye disease but their unwanted effects can be severe and even sight-threatening. They should therefore be prescribed only by ophthalmologists, or by optometrists registered as Independent Prescribers, as these are the only two professional groups properly trained and equipped to diagnose and manage complications.
  • Immunosuppressive agents are not needed in simple allergic eye disease, but they may be used in the management of VKC and AKC under the guidance of an ophthalmologist.
  • Immunotherapy may help a small number of people whose allergic eye disease is caused by a single allergen, rather than by a number of allergens. By giving very small doses of the allergen at regular intervals for three years or more, either by injection or tablets under the tongue, the body can be desensitised.

For more information download our Allergic Eye Disease Factsheet and Allergic Eye Disease leaflet.

What is VKC and AKC?

In addition to seasonal and perennial allergic conjunctivitis, other much rarer, but very serious allergic eye diseases exist. These are vernal keratoconjunctivitis (VKC), which occurs in some severely allergic children. It seems to be more common in boys and also in children with severe atopic dermatitis. There is also the adult equivalent, atopic keratoconjunctivitis (AKC). In both of these conditions the cornea is usually involved, affecting and even threatening the sight of the eye, and only an eye specialist (ophthalmologist) is fully equipped to manage them.

In mild cases, inflammation causes itching and redness. In more severe cases the surface under the top eye lid can become inflamed and swollen bumps (called papillae) can form. These are sometimes known as cobblestones because of their appearance. When the eye closes these can rub on the front of the eye causing pain and irritation.

Signs that your child might be having a flare up of VKC:

  • Droopy eye
  • Discharge from the eye
  • Sticky or watery eyes
  • Soreness/itchiness when blinking
  • Prolonged or unusual blinking
  • Pressing on the eyes
  • Difficulty opening eyes, especially
  • in the morning
  • Difficulty going out in the light
  • Blurred vision

For more information on VKC, download our Living with VKC Leaflet.

Understanding VKC: Comic Book by JumoHealth

This comic book by JumoHealth is a great resource to help children understand the condition:

Understanding Vernal Keratoconjunctivitis (VKC) Comic Book (allergyuk.org)

Thank you Santen for supporting and funding this resource, and to JumoHealth for working in partnership with Allergy UK.

Sam & Tracey's Story

Follow Tracey’s emotional nine year journey, from her son Sam’s first terrifying anaphylactic shock at just four months old, and through her battle to get him the diagnosis and treatment needed for his multiple complex and life altering allergies.

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