As of Thursday, November 20, 2014
DEAR DOCTOR K: I have allergies, and my eyes are affected the most. They’re puffy, red and itchy. What can I do?
DEAR READER: Pollens, animal dander, dust mites and mold: The same allergens that cause sneezing and an itchy nose and throat can trigger allergy symptoms that affect your eyes, too. If your eyes are red and itchy, you may also have tearing, mucous discharge and swelling of your conjunctiva (the inside of your eyelid). This constellation of symptoms is known as allergic conjunctivitis. It can be uncomfortable, but it is not a threat to vision.
To help improve your symptoms, try to avoid whatever triggers your allergies. If you are allergic to cats, avoid them, or at least don’t touch your eyes when near one. If pollen is your nemesis, keep your windows closed. And keep an air purifier or air conditioner going in pollen season.
A simple but effective remedy is to place a cool, wet washcloth over your eyes. Also, use artificial tears (available without prescription) frequently. They’ll give you some relief and help wash away allergens.
Try not to rub your eyes. Doing so causes mast cells, which play a key role in allergic reactions, to release inflammation-causing chemicals into the eye. This makes symptoms worse.
If your symptoms appear occasionally, try one of the newer generation of antihistamines you can take by mouth. Antihistamines block the action of histamine, a major cause of itchy eyes. Over-the-counter options include loratadine (Claritin), cetirizine (Zyrtec) and fexofenadine (Allegra). Others are available by prescription.
Another option is eye drops that contain mast cell stabilizers, which limit release of the inflammation-causing chemicals. During an allergy attack, eye drops work faster than pills taken by mouth.
Eye drops that contain antihistamines and decongestants (medicines that cause small blood vessels to narrow) are available over the counter. They can provide quick relief, particularly of the redness in the eye. But don’t use these medications for more than a week or two, as they can cause excessive narrowing of the blood vessels in your eye. And be prepared for a little redness to return after you’ve stopped using them.
If your symptoms persist, try eye drops that combine a mast cell stabilizer and an antihistamine. These drugs are available over the counter and by prescription.
If you use multiple types of eye drops, such as drops containing an antihistamine and artificial tears, don’t put both drops in your eye at the same time. Wait about five minutes between putting the two types of drops in your eye. Otherwise, the second type you put in your eye may wash away the effects of the first type.
If your symptoms are severe and don’t improve with other medications, ask your doctor about prescription eye drops that contain corticosteroids. These medications help control inflammation, but they should only be used under the guidance of an eye specialist (ophthalmologist). Without proper monitoring, corticosteroid eye drops can cause glaucoma, cataracts or other serious complications.
Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.