Diagnosis

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To make the diagnosis, your eye care professional must identify the type of allergic condition you are experiencing. The eye care professional begins by asking you questions to create a thorough medical history for you and to rule out the possibilities of other eye problems. In particular, your doctor will ask you to describe your symptoms and when they occur most frequently. The main indication of ocular allergies is itching, often accompanied by redness, swelling of the conjunctiva (the transparent membrane covering the eyeball and undersurface of the eyelid), eyelid swelling, light sensitivity, "grittiness," and sometimes tearing or mucous.

The health care professional will also examine your eyes thoroughly, looking for some of the classic signs of ocular allergy: fluid inside certain tissue layers in the eyes, more than normal visible redness of the blood vessels in the eyes, droopy or puffy eyelids, and mucus discharge. In some people, congestion of the blood vessels in and around the eyes can cause dark circles to form around the eyes, called "allergic shiners." Eyelid swelling is also a sign of seasonal allergic conjunctivitis that can have permanent effects on the skin surrounding the eye. The acute reaction can cause rapid swelling and gradual "deflation," which, over time and repetition, can damage the collagen fibers and thin skin surrounding the eye, lending the appearance of drooping, wrinkly or sagging eyelids.

Many people also have itchy and runny noses. Some doctors may take a sample of your eyes' tears for laboratory analysis to help identify what is causing your eyes to have an allergic response. It is important for the doctor to determine that you are indeed having an allergic reaction. Other eye problems, such as viral or bacterial conjunctivitis, dry eyes, or a condition called blepharitis, a condition that occurs when tiny oil glands located near the base of the eyelashes malfunction, can cause similar symptoms. If you do not respond to treatment, you should be treated by a specialist such as an allergist/immunologist or an ophthalmologist.

Although the seasonal and perennial allergic conjunctivitis discussed above are the most common types of eye allergies, there are also four other types, which, as mentioned above, are rare. While seasonal and perennial allergic conjunctivitis represent 80 to 90 percent of ocular allergy cases, the severe forms described here make up the remaining 10 to 20 percent.

Vernal keratoconjunctivitis usually occurs in adolescent boys, with symptoms first appearing between the ages of three and 20. It is typically a seasonally recurring disease, not typically present perennially. Often, children who suffer from eczema, asthma or sinus allergies will find themselves experiencing eye allergies as well. The symptoms are similar but more severe than those of allergic conjunctivitis, including intensely itchy eyes that burn and feel as if something has entered the eye to irritate it. Light sensitivity and blurred vision may be present. This condition is considered to be potentially vision threatening.

Atopic keratoconjunctivitis usually occurs in adults who are highly sensitive to allergens and is associated with asthma, rhinitis, skin rashes, or food allergies. Patients usually have the same signs and symptoms as those with the more common types of eye allergies, except that these patients have perennial inflammation and are at risk for cataracts or conjunctival and corneal scarring. There is usually lid swelling, particularly on the lower lid, and the skin is scaly and wrinkled. Corneal ulcers may form.

Contact lens-associated papillary conjunctivitis, also called giant papillary conjunctivitis, or GPC, is a reaction to ill-fitting contact lenses, contact lens overuse or to their solutions. People who wear disposable or gas permeable lenses are less likely to develop this reaction. It is not a true allergy. Early symptoms include blurred vision from the accumulation of deposits on the contact lens surface, itching and mucous discharge from the eyes, especially following sleep. Over time, you may be unable to tolerate the lenses in your eyes.

Contact ocular allergy or toxic keratoconjunctivitis can result from a reaction to medications used in or around the eye, such as antibiotics and antivirals and other medications. It may also result from other types of substances, such as preservatives in some eyewashes and eye drops, or from chemicals found in cosmetics and hair spray, when used beyond the indicated dosing. Fluid in and around the eye is a typical sign, and the skin around the eyes and eyelids may show signs of an allergic reaction (redness, puffiness and/or vertical wrinkles). Symptoms improve when you stop using the product that is causing the problem.