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Patient information: Allergic conjunctivitis (Beyond the Basics) Author Reza Dana, MD, MPH, MSc Section Editor Jonathan Trobe, MD Deputy Editor Anna M Feldweg, MD Find Print ALLERGIC CONJUNCTIVITIS OVERVIEW Conjunctivitis, also called "pink eye," is defined as an inflammation of the conjunctiva. The conjunctiva is the thin membrane that lines the inner surface of the eyelids and the whites of the eyes (called the sclera) ( figure 1 ). Conjunctivitis can affect children and adults. The most common symptoms of conjunctivitis include a red eye and discharge. There are many potential causes of conjunctivitis, including bacterial or viral infections and allergies. All types of conjunctivitis cause a red eye, although not everyone with a red eye has conjunctivitis. The term “pink eye” refers primarily to conjunctivitis caused by viruses (such as adenoviruses), rather than other causes. Therefore, this term should not be used when the underlying cause of the conjunctivitis is unknown or is not thought to be viral. This topic review discusses the signs and symptoms, evaluation, and treatment of allergic conjunctivitis. Other types of conjunctivitis are discussed separately. (See "Patient information: Conjunctivitis (pinkeye) (Beyond the Basics)" .) ALLERGIC CONJUNCTIVITIS CAUSES Allergic conjunctivitis is caused by airborne allergens that come in contact with the eye. Symptoms may be sudden in onset (acute), seasonal, or present year-round (perennial), depending upon the allergen. Acute allergic conjunctivitis  — Acute allergic conjunctivitis is a sudden-onset reaction that occurs when a person comes in contact with a known allergen, such as cat dander. Symptoms include intense episodes of itching, redness, tearing, and swelling of the eyelid. Symptoms can be severe, although they usually resolve within 24 hours of removal of the allergen. Seasonal allergic conjunctivitis  — Seasonal allergic conjunctivitis (SAC) is a form of eye allergy that usually causes milder but more persistent symptoms during a particular pollen season(s). Seasonal allergens include tree pollens in the spring, grass pollens in the summer, and weed pollens in the late summer and fall, although there is some variation based upon geographic location ( figure 2 ).

Seasonal allergic conjunctivitis  — Seasonal allergic conjunctivitis (SAC) is a form of eye allergy that usually causes milder but more persistent symptoms during a particular pollen season(s). Seasonal allergens include tree pollens in the spring, grass pollens in the summer, and weed pollens in the late summer and fall, although there is some variation based upon geographic location ( figure 2 ). Perennial allergic conjunctivitis  — Perennial allergic conjunctivitis (PAC) is a mild, chronic, allergic conjunctivitis related to year-round environmental, usually indoor, allergens such as dust mites, animal danders, and molds. ALLERGIC CONJUNCTIVITIS SYMPTOMS The most common symptoms of allergic conjunctivitis include redness, watery discharge, and itching of both eyes. Other symptoms can include burning, sensitivity to light, and swelling of the eyelids. Both eyes are usually affected, although symptoms may be worse in one eye. Rubbing the eyes can worsen symptoms. People with allergic conjunctivitis often have a history of other allergic conditions, such as eczema, seasonal allergies, or a specific allergy (eg, to cats). ALLERGIC CONJUNCTIVITIS TREATMENT There are a number of treatments available for the symptoms of allergic conjunctivitis. In addition, basic eye care is important. Basic eye care Avoid rubbing the eyes. If itching is bothersome, use artificial tears, a cool compress, or antihistamine eye drops. (See 'Medications' below.) Minimize exposure to pollen by staying inside when possible, using air conditioning, and keeping car and home windows closed during the peak allergy seasons ( figure 2 ). (See "Patient information: Allergic rhinitis (seasonal allergies) (Beyond the Basics)" .) People with year round allergic conjunctivitis should consider consulting an allergy specialist to determine which allergens are responsible for their symptoms (eg, dust mites, cat dander, others). Medications People with sudden-onset symptoms can use a combination antihistamine/vasoconstrictor eye drop four times daily for up to two weeks. These are available without a prescription. People with seasonal or year round symptoms are usually treated with a combination antihistamine/mast cell stabilizer eye drop. Most of these require a prescription. Ketotifen is an eye drop in this category that is available without a prescription.

People with sudden-onset symptoms can use a combination antihistamine/vasoconstrictor eye drop four times daily for up to two weeks. These are available without a prescription. People with seasonal or year round symptoms are usually treated with a combination antihistamine/mast cell stabilizer eye drop. Most of these require a prescription. Ketotifen is an eye drop in this category that is available without a prescription. An oral antihistamine may be most helpful when it is taken preventively (before symptoms develop). However, antihistamines may also be used to treat symptoms after they have started, although the greatest benefit may not be seen for several days. Non-sedating oral antihistamines include fexofenadine (generic, Allegra®), loratadine (generic, Claritin®), desloratadine (Clarinex®), cetirizine (generic, Zyrtec®), and levocetirizine (Xyzal®). Loratadine and cetirizine are available in the United States without a prescription. Diphenhydramine (Benadryl®) is a short-acting, sedating antihistamine that can be taken at bedtime to reduce night-time itching. If symptoms of allergic conjunctivitis do not improve after two to three weeks of the above treatments, the person should see an ophthalmologist for evaluation. Treat dry eyes  — People with allergic conjunctivitis often produce an inadequate amount of tears, which can cause dryness of the eye. This can worsen symptoms of allergic conjunctivitis. However, it is not always possible to know if a person has inadequate tear production unless an eye examination is performed. If inadequate tear production is diagnosed, treatment often includes use of a lubricant eye drop or ointment. These products are available without a prescription in most pharmacies. Preservative-free preparations are more expensive and are necessary only for people with a severe case of dry eye and those who are allergic to preservatives. Lubricant drops can be used as often as hourly with no side effects. The ointment provides longer lasting relief but blurs vision temporarily. For this reason, some people use ointment only at bedtime. It may be worthwhile to switch brands if one brand of drop or ointment is irritating, since each preparation contains different active and inactive ingredients and preservatives. WHERE TO GET MORE INFORMATION

Lubricant drops can be used as often as hourly with no side effects. The ointment provides longer lasting relief but blurs vision temporarily. For this reason, some people use ointment only at bedtime. It may be worthwhile to switch brands if one brand of drop or ointment is irritating, since each preparation contains different active and inactive ingredients and preservatives. WHERE TO GET MORE INFORMATION Your healthcare provider is the best source of information for questions and concerns related to your medical problem. This article will be updated as needed on our web site ( www.uptodate.com/patients ). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below. Patient level information  — UpToDate offers two types of patient education materials. The Basics  — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Patient information: Conjunctivitis (pinkeye) (The Basics) Patient information: Seasonal allergies in adults (The Basics) Patient information: Photokeratitis (Arc eye) (The Basics) Patient information: Seasonal allergies in children (The Basics) Patient information: Allergy shots (The Basics) Patient information: Allergy skin testing (The Basics) Beyond the Basics  — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon. Patient information: Conjunctivitis (pinkeye) (Beyond the Basics) Patient information: Allergic rhinitis (seasonal allergies) (Beyond the Basics) Professional level information  — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading. Allergic conjunctivitis Conjunctivitis Evaluation of the red eye

Professional level information  — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading. Allergic conjunctivitis Conjunctivitis Evaluation of the red eye The following organizations also provide reliable health information. National Library of Medicine ( www.nlm.nih.gov/medlineplus/healthtopics.html ) National Institute of Allergy and Infectious Diseases (NIAID) ( www.niaid.nih.gov ) Allergy, Asthma, and Immunology Online ( www.acaai.org ) American Academy of Allergy, Asthma, and Immunology ( www.aaaai.org ) [ 1-3 ] Literature review current through: Oct 2013. | This topic last updated: Apr 8, 2013. Find Print The content on the UpToDate website is not intended nor recommended as a substitutefor medical advice, diagnosis, or treatment. Always seek the advice of your own physician orother qualified health care professional regarding any medical questions or conditions. Theuse of this website is governed by the UpToDate Terms of Use ©2013 UpToDate, Inc. References Top Greiner JV, Michaelson C, McWhirter CL, Shams NB. Single dose of ketotifen fumarate .025% vs 2 weeks of cromolyn sodium 4% for allergic conjunctivitis. Adv Ther 2002; 19:185. Ousler GW 3rd, Workman DA, Torkildsen GL. An open-label, investigator-masked, crossover study of the ocular drying effects of two antihistamines, topical epinastine and systemic loratadine, in adult volunteers with seasonal allergic conjunctivitis. Clin Ther 2007; 29:611. Yaylali V, Demirlenk I, Tatlipinar S, et al. Comparative study of 0.1% olopatadine hydrochloride and 0.5% ketorolac tromethamine in the treatment of seasonal allergic conjunctivitis. Acta Ophthalmol Scand 2003; 81:378.

©2013 UpToDate ® Print Email Allergic conjunctivitis Allergic conjunctivitis typically presents as bilateral redness, watery discharge, and itching. Reproduced with permission from: Trobe, JD. The Eyes Have It: An interactive teaching and assessment program on vision care. WK Kellog Eye Center, University of Michigan. Copyright © Jonathan D Trobe, MD.

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