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Allergic Conjunctivitis

(Atopic Conjunctivitis; Atopic Keratoconjunctivitis; Hay Fever Conjunctivitis; Perennial Allergic Conjunctivitis; Seasonal Allergic Conjunctivitis; Vernal Keratoconjunctivitis)


Zeba A. Syed

, MD, Wills Eye Hospital

Reviewed/Revised Apr 2023
Topic Resources

Allergic conjunctivitis is inflammation of the conjunctiva caused by an allergic reaction.

  • Allergic reactions caused by, for example, airborne allergens, may inflame the conjunctiva.

  • Redness, itching, swelling, tearing, and stringy discharge are common.

  • Various eye drops may help decrease symptoms and inflammation.

The Conjunctiva

The conjunctiva (the membrane that lines the eyelid and covers the white of the eye) contains a large number of cells from the immune system (called mast cells) that release chemical substances (called mediators) in response to a variety of stimuli (such as pollens, mold spores, or dust mites). These mediators cause inflammation in the eyes, which may be brief or long-lasting. About 20% of people have some degree of allergic conjunctivitis. (See also Overview of Conjunctival and Scleral Disorders Overview of Conjunctival and Scleral Disorders The conjunctiva is the membrane that lines the eyelid and loops back to cover the sclera (the tough white fiber layer covering the eye), right up to the edge of the cornea (the clear layer in... read more .)

An Inside Look at the Eye

An Inside Look at the Eye

Seasonal allergic conjunctivitis (hay fever conjunctivitis) and year-round or perennial allergic conjunctivitis (atopic conjunctivitis, atopic keratoconjunctivitis) are the most common types of allergic reaction in the eyes. Seasonal allergic conjunctivitis is often caused by mold spores or tree, weed, or grass pollens, leading to its typical appearance in the spring and early summer. Weed pollens are responsible for symptoms of allergic conjunctivitis in the summer and early fall. Perennial allergic conjunctivitis occurs year-round and is most often caused by dust mites or animal dander.

Vernal keratoconjunctivitis is a more serious form of allergic conjunctivitis in which the stimulant (allergen) is not known. The condition is most common among boys, particularly those aged 5 to 20 years who also have eczema, asthma, or seasonal allergies. Vernal keratoconjunctivitis typically reappears each spring and subsides in the fall and winter. Many children outgrow the condition by early adulthood.

Symptoms of Allergic Conjunctivitis

People with all forms of allergic conjunctivitis develop intense itching and burning in both eyes. Although symptoms usually affect both eyes equally, rarely one eye may be more affected than the other. The conjunctiva becomes red and sometimes swells, giving the surface of the eyeball a puffy appearance. The eyelids may become intensely itchy. Rubbing and scratching leads to eyelid skin redness, swelling, and a crinkly appearance.

With seasonal allergic conjunctivitis and perennial allergic conjunctivitis, there is often a large amount of thin, watery discharge. At times the discharge is stringy. Vision is seldom affected. Many people have an itchy, runny nose.

With vernal keratoconjunctivitis, the eye discharge is thick, stringy, and mucuslike. Unlike other types of allergic conjunctivitis, vernal keratoconjunctivitis often affects the cornea (the clear layer in front of the iris and pupil), and in some people painful, small, open sores (corneal ulcers Corneal Ulcer A corneal ulcer is an open sore on the cornea (the clear layer in front of the iris and pupil) that is usually caused by an eye infection. Contact lenses, injuries, disorders, drugs, and nutritional... read more Corneal Ulcer ) develop. These ulcers cause deep eye pain with exposure to bright light (photophobia) and sometimes lead to a permanent decrease in vision.

Diagnosis of Allergic Conjunctivitis

  • A doctor's evaluation of the symptoms and appearance of the eye

Doctors recognize allergic conjunctivitis by its typical appearance and symptoms. Tests are rarely needed or useful.

Treatment of Allergic Conjunctivitis

  • Eye drops and tear supplements

Allergic conjunctivitis treatment includes anti-allergy eye drops. Using chilled tear supplements and cold compresses and avoiding known allergens can help reduce symptoms.

Drops that have an antihistamine, such as ketotifen, may be enough for mild cases. This medication can be bought without a prescription. If ketotifen is insufficient, prescription antihistamine eye drops (such as olopatadine or cetirizine) or mast cell stabilizers (such as nedocromil) may be effective. An alternative option for chronic symptoms is topical cyclosporine.

Nonsteroidal anti-inflammatory eye drops, such as ketorolac, help relieve symptoms. Corticosteroid eye drops have more potent anti-inflammatory effects. However, these eye drops should not be used for more than a few weeks without close monitoring by an ophthalmologist (a medical doctor who specializes in the evaluation and treatment [surgical and nonsurgical] of eye disorders) because they may cause increased pressure in the eyes (glaucoma Glaucoma Glaucomas are a group of eye disorders characterized by progressive optic nerve damage (often, but not always, associated with increased eye pressure) that can lead to irreversible loss of vision... read more ), cataracts Cataract A cataract is a clouding (opacity) of the lens of the eye that causes a progressive, painless loss of vision. Vision may be blurred, contrast may be lost, and halos may be visible around lights... read more Cataract , and an increased risk of eye infections.

Antihistamines taken by mouth, such as fexofenadine, cetirizine, or hydroxyzine, may also be very helpful, especially when other areas of the body (for example, ears, nose, throat) are affected by the allergies.

Drugs Mentioned In This Article

Generic Name Select Brand Names
Alaway, Children's Alaway, Claritin Eye, Eye Itch Relief, Itchy Eye, Zaditor, Zyrtec Itchy Eye
Pataday, Patanase, Patanol, Pazeo
All Day Allergy , All Day Allergy Children's, Allergy Relief, Children's Allergy Relief, PediaCare Children's Allergy, Quzyttir, ZERVIATE, Zyrtec, Zyrtec Chewable, Zyrtec Children's, Zyrtec Children's Allergy , ZYRTEC Children's Dye Free, Zyrtec Children's Hives , Zyrtec Dissolve, ZYRTEC Dye Free, Zyrtec Hives Relief , Zyrtec Liquid Gel , Zyrtec Pre-Filled Spoons, Zyrtec Syrup
Alocril, Tilade
Cequa, Gengraf , Neoral, Restasis, Sandimmune, SangCya, Verkazia
Acular, Acular LS, Acular PF, Acuvail , SPRIX, Toradol
Allegra, Allegra Allergy 12 Hour , Allegra Allergy 24 Hour, Allegra Children's Allergy , Allegra Children's Allergy ODT, Allegra Hives, Allegra ODT, Allergy Relief, Children's Allergy
ANX , Atarax, Hyzine , Rezine, Vistaril, Vistaril Solution, Vistaril Suspension
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