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Allergic Conjunctivitis – Symptoms and Treatment

Allergic conjunctivitis is an inflammatory reaction of the eye´s conjunctiva triggered by allergens such as pollen or pet dander. It causes redness, itching, and watery eyes.

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Things worth knowing about "Allergic Conjunctivitis"

Allergic conjunctivitis is an inflammatory reaction of the eye´s conjunctiva triggered by allergens such as pollen or pet dander. It causes redness, itching, and watery eyes.

What is Allergic Conjunctivitis?

Allergic conjunctivitis is an inflammation of the conjunctiva – the thin mucous membrane that covers the white part of the eyeball and lines the inside of the eyelids – triggered by exposure to specific allergens. It is one of the most common allergic eye conditions worldwide and can occur either seasonally or throughout the year.

Causes

Allergic conjunctivitis is caused by allergens that trigger an overreaction of the immune system in sensitized individuals. The most common triggers include:

Pollen (grasses, trees, weeds) – the main cause of the seasonal form
House dust mites – a frequent cause of the perennial form
Pet dander and animal hair (e.g., cats, dogs)
Mold spores
Cosmetics and eye drops (contact allergy)

During an allergic reaction, allergens bind to immunoglobulin E (IgE) antibodies on mast cells in the conjunctiva, triggering the release of histamine and other inflammatory mediators that cause the characteristic symptoms.

Symptoms

Symptoms of allergic conjunctivitis are typically bilateral and include:

Intense itching of the eyes (the hallmark symptom)
Redness of the conjunctiva (conjunctival injection)
Excessive tearing (epiphora)
Burning and foreign body sensation
Light sensitivity (photophobia)
Swollen eyelids
Watery to mucous discharge

Symptoms often occur alongside other allergic conditions such as hay fever (allergic rhinitis) or asthma.

Types of Allergic Conjunctivitis

Seasonal Allergic Conjunctivitis (SAC)

The most common form, triggered by pollen. Symptoms occur seasonally – typically in spring and summer – and resolve after the pollen season ends.

Perennial Allergic Conjunctivitis (PAC)

A year-round form, most commonly caused by house dust mites, pet dander, or mold. Symptoms are usually less intense but persistent throughout the year.

Vernal Keratoconjunctivitis (VKC)

A more severe and rare form that primarily affects children and adolescents in warmer climates. It can damage the corneal tissue and requires close ophthalmological monitoring.

Atopic Keratoconjunctivitis (AKC)

A chronic, severe form often seen in adults with atopic dermatitis (eczema). If left untreated, it may lead to permanent eye damage.

Diagnosis

Diagnosis is usually made clinically, based on the patient's history and typical symptoms. The following examinations may be performed:

Slit-lamp examination: Detailed assessment of the conjunctiva and cornea by an ophthalmologist
Allergy testing: Skin prick test or specific IgE blood test to identify the triggering allergens
Conjunctival provocation test: Direct application of an allergen to the conjunctiva (in specialized centers)
Cytological smear: Detection of eosinophils in the conjunctiva as a sign of allergic inflammation

Treatment

Allergen Avoidance

The most important measure is avoiding the triggering allergen. For pollen allergy, wearing sunglasses outdoors, washing hair regularly, and keeping windows closed during high pollen counts are recommended.

Pharmacological Treatment

Antihistamine eye drops (e.g., azelastine, olopatadine): Quickly and effectively reduce itching and redness
Mast cell stabilizers (e.g., cromoglicate, lodoxamide): Preventive effect by inhibiting histamine release
Topical corticosteroids (e.g., loteprednol): For severe or treatment-resistant cases, only for short-term use under medical supervision
Systemic antihistamines (oral): Useful when hay fever symptoms are present simultaneously
Artificial tears: To relieve burning and foreign body sensation and to flush out allergens

Specific Immunotherapy (Desensitization)

Allergen immunotherapy (AIT) is the only causal treatment available. By gradually accustoming the immune system to the allergen, long-term reduction or elimination of symptoms can be achieved. It is particularly recommended for severe or year-round pollen allergy.

When to See a Doctor?

Medical attention should be sought promptly if symptoms are severe, persistent, or occurring for the first time, or if there is vision impairment, light sensitivity, or suspicion of an eye infection. Severe forms such as vernal or atopic keratoconjunctivitis require close specialist follow-up to prevent corneal damage.

References

Leonardi A. et al. - Allergic conjunctivitis: a comprehensive review of the literature. Italian Journal of Allergy and Clinical Immunology, 2015.
Bielory L., Meltzer E.O., Nichols K.K. et al. - An algorithm for the management of allergic conjunctivitis. Allergy and Asthma Proceedings, 2013; 34(5): 408-420.
World Allergy Organization (WAO) - White Book on Allergy: Update 2013. Available at: www.worldallergy.org

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