Eye-related symptoms include itching, burning, watering, dry eyes and redness. Allergies and nonallergic ailments such as viruses and bacterial infections can trigger these symptoms.  

Allergens such as pollens and molds, foods, latex, medications and many others can cause eyes to water, itch and burn. In addition, allergic conjunctivitis is a condition in which allergens directly affect the eyes and cause symptoms.

Allergies affect the eyes because the mucous membrane covering the front of the eye and the inner eyelid (conjunctiva) contains mast cells. These are the cells that release histamine and other chemicals that trigger symptoms of an allergic reaction.

Nonallergic ailments that can trigger eye symptoms include viral conjunctivitis (known as “pink eye”) and bacterial conjunctivitis. Viral conjunctivitis is much more common.

Eye-related allergy symptoms rarely have long-term consequences for a person’s vision if treated promptly. However, the discomfort they cause can interfere with a person’s day-to-day activities. Many medications are available to treat these symptoms.

Eye-related symptoms accompany many different types of allergic and nonallergic conditions (including viruses and bacterial infections). They are among the most common symptoms associated with seasonal allergies and other types of allergic reactions.

Some of the most common eye-related symptoms associated with allergies include:

• Watery eyes. Tears help lubricate the eyes and wash away foreign bodies and particles. However, in some cases the eyes produce excessive amounts of tears or drain improperly. Eyes can water for many reasons, including the presence of allergies. Other sources of watery eyes include blocked tear ducts or irritation due to various factors (e.g., dryness, foreign bodies).
  
  
• Itchiness and burning. Histamine and other chemicals released during an allergic reaction produce these symptoms. Viral and bacterial infections also can cause these symptoms, as can exposure to pollutants such as cigarette smoke or industrial pollution.
  
  
• Redness. A healthy eye should have red blood vessels that are visible. However, chronic and excessive redness is a sign that the eyes are irritated, possibly by an allergy. Other factors, such as excessive coughing, also can cause this symptom.
  
  
• Black circles around the eyes. Sometimes known as “allergic shiners,” they are the result of constant rubbing and scratching of the skin, which causes a darkening effect.
  
  
• Light sensitivity (photophobia). This is an inability of a person to tolerate light, especially bright light. It may be related to allergies or a more serious condition, such as uveitis, dry eye or cataract.
  
  
• Swelling of the eyelid.

Eye-related symptoms may indicate a condition that requires immediate emergency care. Other symptoms may need less immediate attention from a physician.

A person should call 9-1-1 or seek immediate medical care from an ophthalmologist for the following symptoms:

• Any type of penetrating injury
• Headache coupled with blurred vision or confusion
• Nausea and vomiting associated with eye pain and blurry vision

A person should schedule an appointment with an ophthalmologist if experiencing the following symptoms:

• Eye redness longer than one to two days
• Eye pain and/or vision changes
• Presence of objects in the eye
• Sensitivity to light (photophobia)
• Yellow, greenish or excessive discharge from the eye

Patients taking anticoagulants should also contact their physician when eye-related symptoms develop.

Many types of allergic and nonallergic conditions can trigger eye-related symptoms. Allergens that commonly cause eye-related symptoms include:

• Pollens
• Molds
• Dust
• Pet dander
• Latex

An allergic condition known as allergic conjunctivitis directly affects the eyes. It affects up to 22 percent of the U.S. population, according to the American College of Allergy, Asthma and Immunology (ACAAI). Allergic conjunctivitis manifests in three major forms:

• Seasonal allergic conjunctivitis (SAC). The most common form of allergic conjunctivitis, it occurs seasonally as plants pollinate and produce airborne allergens such as grass, tree and weed pollens, and molds.
  

  

• Perennial allergic conjunctivitis (PAC). A less common form of allergic conjunctivitis in which symptoms are experienced all year long. The main allergens involved in PAC are animal dander, dust mites and Down feathers.
  
  
• Vernal conjunctivitis. A chronic form of allergic conjunctivitis that occurs most often in the spring and fall. It has the potential to permanently damage vision and is more likely to occur in boys than in girls.

Itchiness is the symptom most often associated with allergic conjunctivitis, according to the ACAAI. Other symptoms include redness, tearing, burning and blurred vision.

An overall allergic reaction is likely to also trigger symptoms not related to the eyes. These include:

• Runny nose
• Nasal congestion

Nonallergic factors that can produce eye–related symptoms include:

• Viral conjunctivitis. Known as “pink eye,” it is caused by a virus.
  
  
• Bacterial conjunctivitis. Also known as “pink eye,” it is caused by bacterial infection.
  
  
• Blepharitis. Inflammation of the eyelids that can cause symptoms in the eyes and lids.
  
  
• Corneal ulcers. Usually caused by a bacterial, fungal, amoebic or viral infection that affects the clear front window (cornea) of the eye.
  
  
• Keratoconjunctivitis sicca. Reduced tear production sometimes known as “dry eye.” Most often afflicts seniors, but can occur at any age.
  
  
• Uveitis. Inflammation of the uvea, which includes the iris, ciliary body (the set of muscles that focuses the lens of the eye and produces the fluid in the eye) and choroid (the outer lining of the back of the eye).
  
  
• Airborne irritants, including tobacco smoke and smog.
  
  
• Chemical irritants, including cosmetics and pool chlorine.
  
  
• Obstruction of tear duct. A blockage in the tear passage that runs from the eyes to the nasal cavity. Most often afflicts babies.
  
  
• Foreign objects in the eye.
  
  
• Aged lids entropion (lids turning in) and ectropion (lids turning out).

Many people with allergies experience eye-related symptoms during flare-ups. Allergies affect the eyes because the mucous membrane covering the white part of the eye and the inner eyelid (conjunctiva) contains mast cells. During an allergic reaction, an allergen triggers a mast cell to burst, releasing histamine and other chemicals that cause symptoms. The result for the eyes is swelling, inflammation, burning and itchiness.

Symptoms such as watery eyes, itchiness, burning and redness are common for those with allergic rhinitis, latex allergies, food allergies and many other types of allergy conditions.

A physician will conduct a physical examination and compile a patient’s medical history and list of symptoms. An exam will include a vision check. Also, a physician will check eye motion and examine the eyelids and the reaction of the pupils to light. The physician is also likely to ask several questions, such as:

• When did symptoms begin?
  
  
• What symptoms are present? These might include:
  
• • Eye discharge, burning, itching or light sensitivity
  • Nausea or vomiting
  • Headache
    
    
• Has vision been affected?
  
  
• Are both eyes affected, or just one? If just one, which one?
  
  
• Is the white of the eye affected, or another part?
  
  
• Did redness come on suddenly, and is there a prior history of redness?
  
  
• Is eye pain present? If so, does it get worse with eye movement?
  
  
• Does it feel like something is in the eye?
  
  
• Do symptoms become worse at certain times or in certain situations?
  
  
• Does nasal congestion or runny nose accompany eye-related symptoms?

If an allergy or allergic conjunctivitis is suspected, testing will sometimes take place to identify the specific allergen triggering symptoms.

Other eye-related tests or examinations may take place to determine if symptoms are related to a non-allergic cause, such as an infection or systemic disease.

There are many prescription and over-the-counter medications that can help soothe eye-related symptoms. Symptoms related to allergies can best be addressed by treatments that prevent or soothe allergic reactions. Patients should not take any medications without first consulting a physician. Overuse of some drugs can cause a rebound effect, which eventually makes symptoms worse instead of better.

Though some allergy medications are taken orally, others come in eye drops and can be directly applied to the eyes.  It is important to ensure that eye drop medication not only reaches the eye, but that it is fully absorbed so that the eye receives the maximum benefit of the drug.

Specific eye drop medications used to ward off allergy symptoms include:

• Antihistamines. Block the work of histamine, a chemical released during allergic reactions.
  
  
• Mast cell stabilizers. Stabilize mast cells and keep them from bursting and releasing histamine and other chemicals.
  
  
• Nonsteroidal anti-inflammatory drugs (NSAIDs). Relieve inflammation that sometimes accompanies allergies.
  
  
• Corticosteroids. Reduce inflammation. However, they are not commonly prescribed because they can also make certain infections worse (e.g., herpes). They may also trigger side effects such as secondary infections, glaucoma and cataracts. If they are prescribed, they should only be used for a short time and under strict supervision of a physician.
  
  
• Artificial tears. These can be used to wash allergens from the eyes, and to keep dry eyes moist.
  
  
• Decongestants. These drugs reduce redness by constricting the red blood vessels in the eye. They are available alone or in combination with antihistamines.

Non-allergic eye-related conditions often require treatments different from those related to allergies. These may include:

• Viral conjunctivitis. This condition usually resolves by itself after about 10 days. Patients should wash their hands often and avoid touching the affected eye or the eyes of others. Occasionally, the cornea (clear portion in front of the eyeball) will become inflamed. This may require steroid or antiviral treatment.
  
  
• Bacterial conjunctivitis. Antibiotic eye drops and/or ointment may be prescribed.
  
  
• Dry eye. Artificial tears are the most common treatment. Punctal occlusion surgery may be used, in which a plug is placed in one of two ducts between the eye and the nose to keep tears from flowing into the nose.
  
  
• Irritation. Thorough eye washing is necessary when symptoms are triggered by eye contact with household cleaners, sprays, smoke, smog and other pollutants. 

Patients can also take other steps to relieve both allergic and non-allergic symptoms, including:

• Avoiding exposure to allergens. Patients are urged to take steps to limit their exposure to allergens. Examples may include remaining indoors when pollen counts are high, keeping the home clean to reduce the levels of various allergens and irritants and washing hands immediately after petting animals.
  
  
• Applying cold compresses to their eyes to relieve symptoms. Cold acts as a mast cell stabilizer and vasoconstrictor. Rubbing or scratching the eyes will only make symptoms worse.
  
  
• Using artificial tears to remove mucus or wash irritants from the eye. Refrigerating artificial tears makes them more soothing when used. Patients usually are urged to avoid other types of over-the-counter eyedrops, as they may make symptoms worse over time.
  
  
• Removing eyelid crusts by softening them with warm compresses and using baby shampoo to wash them away. 
  
  
• Not wearing eye makeup until symptoms subside. If an infection was present, eye makeup should be thrown away and replaced.
  
  
• Not wearing contact lenses while symptoms are present. If an infection was present, old lenses should be thrown away and replaced.
  
  
• Resting the eyes and avoiding bright lights.

If medications and avoidance fail to relieve eye-related symptoms, allergy shots (immunotherapy) may be considered. Allergy shots are a form of allergy and asthma treatment in which low doses of an allergen are injected into a patient over a period of time. The goal is to increase the patient’s tolerance to the allergen while reducing symptoms brought on by an allergic reaction. 

The best way to prevent eye-related symptoms is to avoid the allergens, irritants and germs that cause symptoms. This should be done when possible. Other tips for preventing eye-related symptoms include:

• Wash hands often to reduce allergic and infectious contamination. Germs and allergens can easily be transferred from the fingertips to the eye.
  
  
• Do not rub the eyes, as this will only irritate them and make the condition worse.
  
  
• Wear sunglasses outside to protect the eyes from allergens and other irritants.
  
  
• Wear glasses instead of contact lenses during allergy season.
  
  
• Wash bedding and pillowcases frequently in hot water and detergent to reduce allergens. Avoid Down feather products, if allergic.
  
  
• Avoid wearing eye makeup. Those who choose to continue wearing makeup should never share the products.

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about eye-related symptoms:

1. What eye-related symptoms may I experience as the result of my allergies?
   
   
2. What tests will you use to determine the cause of my eye-related symptoms?
   
   
3. Which types of eye–related symptoms can I treat at home, and which symptoms need to be treated by a doctor?
   
   
4. What are my treatment options?
   
   
5. Is there an underlying condition causing my eye–related symptoms?
   
   
6. How can I prevent eye-related symptoms?
   
   
7. How long will my symptoms last?
   
   
8. What should I do if my symptoms get worse?
   
   
9. Should I expect my symptoms to return in the future?
   
   
10. Will my eye-related symptoms have a permanent effect on my vision?