April showers bring May flowers—and allergies. Spring is great for warmer weather and pretty scenery, but with the blooming landscape we also see an uprise in seasonal allergies.
One of the most commonly reported seasonal allergy complaints is eye irritation. Why does this happen and what can we do about it?
The short answer to this question is inflammation.
An allergen from the environment (pollen, seeds, grass, etc.) is detected by the surface of the eye as a dangerous intruder and triggers an inflammatory response. Basically, once the allergen is detected on the surface of the eye, the body panics a little bit and signals special cells called “mast cells” to release a compound called histamine.
Histamine is like the body’s personal security system. It travels to the site of the allergen and ramps up a response to get rid of it. Some of the ways histamine accomplishes this task is by dilating blood vessels to allow other immune-response cells to travel more easily to the site “under attack” and initiate an upregulation in mucus production.
Another way to think about it is like this: Histamine is the security system coordinating defense mechanisms. It tells the blood vessels to dilate to allow white blood cells, we’ll think of these as the “tanks” of the immune system, to enter the area under attack and “blow-up” the intruder. This dilation in blood vessels is what causes the eyes to look red and swollen.
Histamine also increases mucus production. We’ll think of mucus like a sticky trap that the allergens stick to. What happens when we have a lot of mucus? We cough it out, blow it out our noses, or, in the eyes, blink it out and away. So, the mucous traps the allergens and then we get rid of them in bulk—a pretty smart defense tactic!
However, come allergy season there are A LOT of allergens floating about the air. This means the body is constantly being “attacked” by allergens and more and more histamine is released.
As histamine builds up in the body, we start to experience the typical seasonal allergies symptoms of stuffy/runny nose, coughing, and itchy, watery, red eyes.
Seasonal allergies are a major nuisance, but luckily there are many different treatment options to help control them!
In this section we’ll discuss treatment options ranging from the most simple to the most complex/serious treatment. This article is not endorsing or advocating for any of the products listed, but instead is using various available treatments for example and educational purposes only.
A good place to start for ocular allergy treatment is with an artificial tear. There are many different brands and options for artificial tears. The way these work to help with allergies is similar mucus without causing the itchiness and irritation associated with true histamine-regulated-mucus production.
Artificial tears have some viscosity to them and therefore can trap allergens and “rinse” the eye of them providing immediate relief. However, this relief is often only temporary and may only last a few hours before needing another application of tears.
Artificial tears are probably the cheapest of the allergy treatment options and thus are a great starting point for someone with mild allergy irritation.
When it comes to artificial tears, preservative-free options are always recommended as they do not contain preservatives which can cause additional irritation to the eye. Some examples are Systane, Refresh Tears, Blink Tears, and TheraTears.
Please note when picking out artificial tears to watch for regular artificial tears and “gel” or “nighttime” artificial tears. While these are also great products, they are ointments rather than solutions, meaning they are much thicker and will cause blurry vision for 30-60 minutes post-application. This may be fine if you use them at the end of the day but can be inconvenient during the day when you are working on something.
Oral antihistamines are what most people think about when it comes to allergy medications. They are typically in pill form and sold over the counter for entire body allergy relief.
Oral antihistamines work by inhibiting histamine from exerting its’ effects. In other words, oral antihistamines stop histamine from “giving orders”, resulting in a decrease in blood vessel dilation and decreased mucous production.
Oral antihistamines make a significant impact in reducing the effects of histamine that has already been released from mast cells but is does not completely get rid of it. You may still exhibit some allergy symptoms, but generally the symptoms are much more tolerable.
There are many different oral antihistamines available over the counter. Now a days many are even non-drowsy and last 24 hours! Examples include Zyrtec, Claritin, Xyzal, and Allegra. Each of these is a little different from the other, so you might need to try different brands to determine what works best for you.
Unfortunately, the eye bears the brunt of allergen collection—the eye is a sticky watery surface so of course it attracts allergens! Therefore, while oral antihistamines may help to reduce the overall body response, it may not be quite enough to dampen your eye allergy symptoms.
If artificial tears and oral antihistamines are not getting the job done, there are many more options specifically tailored to the eyes!
There are eyedrops made specifically to reduce redness and others used to relieve irritation and itchiness associated with allergies.
As we discussed previously, one of the main symptoms associated with eye allergies are pink or red eye coloration as a result of the dilated blood vessels. If this is your only concern, not itchy, swollen eyes, an eye drop tailored to simply reduce redness may be the best option for you.
Cosmetic eye drops (eye drops used to reduce redness) work by constricting the blood vessels, making your eyes appear white again. They accomplish this through activating the sympathetic nervous system—this means there is an increased risk for ocular side effects (increased dryness, pupil dilation, etc.) if the drops are used too frequently.
Some examples of cosmetic eye drops to reduce redness are Lumify, Visine, and Clear Eyes. These products are great for short-term use, for example if you need to take pictures that day, or have a big work presentation to give, but should not be used in excess to avoid unwanted side effects.
On the other hand, if your main concern is eye irritation and itchiness, an allergy eye drop may be a better option for you.
Many allergy drops today have antihistamine and mast-cell stabilizing components.
Similar to oral anti-histamines, antihistamine eye drops stop histamine from exerting its effects on the eyes. The eye drop is beneficial in comparison to an oral medication as it is concentrated solely to the eye, making it stronger in terms of eye symptom relief.
In combination to the antihistamine component, many allergy drops also have mast-cell stabilizing components. Mast cell stabilizers stop mast cells from ever releasing histamine, stopping the histamine cascade of events.
The combination of antihistamine and mast-cells stabilizing effects provides immediate allergy relief as well as stopping the production and release of more histamine in the future.
Some examples of over-the-counter antihistamine/mast-cell stabilizer eye drops are Pataday (can be used once a day), Patanol (used twice a day), Zaditor, and Lastacaft.
If all of the above methods are not lessening your allergy symptoms, it is time to see your optometrist. Be sure to write down all of the methods you have previously tried so that they do not recommend something that has not worked for you.
One of the most commonly prescribed options for severe eye allergies is a steroid eye drop. These work by decreasing the inflammation response and calming things down.
While steroids work great for allergy relief, they also have many side effects, so you will need to be monitored closely by your eye doctor. Steroids are mostly utilized to get inflammation under control and then your doctor will switch you to an over-the-counter medication for maintenance.
There are, of course, other options outside of a steroid your eye doctor can prescribe depending on your situation. He or she would be more than happy to discuss these options with you and get you on the right track for allergy relief.