As I walked into the examining room I looked over to the left to greet my patient and his parent. I was dismayed to find them both glassy eyed, with a few light tears around the edges of their eyes.
Immediately I asked if everything was all right. Mom just smiled, looked up and said, “This is why we’re here. Our eyes keep doing this. It seems to get a little better and then, there it is again--itching and tearing.”
I asked the child to sit on the table. I noticed reddened eyes, clear discharge and slightly irritated lids. His eyes moved freely, checking out the posters in the room. There was no pain with that movement. After a few minutes in the room the eyes seemed to calm down with less redness and decreased tearing.
As the child got off the table I asked mom if they suffered from allergies. She answered affirmatively, saying all the family was sniffling and sneezing. But that wasn’t what worried her. It was her and her son’s eyes that really stood out. She was worried that they had pink eye and wanted to get it treated before the rest of the family had a chance to get it.
I explained to mom that we were in luck. She and her son did not have pink eye and would not infect others. However, if the other family members also suffered from allergy symptoms they might have their eyes begin to act the same way as our patient who was demonstrating allergic conjunctivitis.
Allergic conjunctivitis has been a frequent diagnosis lately. We have had dramatic changes in weather, winds and irritants such as smoke and smog. When a person has a sensitivity to these type of changes because of an allergic response the body produces histamine which is released into the blood vessels of the conjunctiva--the clear membrane covering the white of the eye and eyelids. This release causes these areas to redden, tear, and itch. This is just like histamine that may cause similar changes in the skin of those with eczema irritated by allergic triggers. Sometimes those with allergies have their lungs, skin and eyes all reacting to an allergen that is triggered at the same time through the histamine response. I explained to mom that the sneezing and sniffling of her other family members was likely just another variety of the same allergic reaction she and her son were experiencing.
Although mom was relieved to not be contagious, she still was anxious to have relief for her and her son’s irritating symptoms. I shared with her that the definitive treatment for allergic conjunctivitis is to remove the allergen. However, this is often not a possibility with pollens and other environmental agents. I prescribed for her son an antihistamine eye drop that would relieve many of the symptoms he was having and could be used when this response flared. I told her it was important to see some change and resolution to the symptoms, even though they might recur. If the symptoms would not abate there could be the presence of a higher level of inflammation. That would require an exam by an ophthalmologist, who might subsequently recommend the use of a steroid eye drop. For lesser reactions, cool compresses and Visine drops can often be of help. Mom and son left, off to the pharmacy and the family barbeque, and happy not to be quarantined.