Ask the Pharmacist

Q: My itchy eyes are driving me crazy. How can I tell if it’s from allergies or an infection; and if it’s allergies, how can I make it go away?

A: Allergic conjunctivitis (the medical term for the eye symptoms commonly caused by seasonal allergies) is a frequent complaint of many of our patients from early April right up until the first couple of frosts in the fall.

The first key to treatment is to make sure you are treating the right cause of your troublesome symptoms since infections of the eye can closely mimic the symptoms.

Conjunctivitis is an inflammation of the conjunctiva, the moistening tissue which is located inside the eyelid on the white part of the eyeball. As mentioned above, this inflammation can occur as a result of allergies, an infection (by either a virus or bacteria) or by mechanical irritation.

The allergic version occurs equally in both eyes and the symptoms involve persistent itchiness, a clear watery discharge, eyelid swelling, a foreign body sensation, and redness. Occasionally, sufferers will look as if they have a black eye. It is not contagious and will persist as long as the allergens are in the air.

Infectious conjunctivitis comes on very fast. Initially, only one eye is infected but due to its extreme contagiousness, the other eye often follows suit within a few days. The eye tends to be bothered by a thicker, stickier but still watery discharge if the cause is a virus whereas the bacterial version often is associated with a greenish-yellowish pus that accumulates and can cause your eye to be almost glued shut in the morning.

All versions of conjunctivitis can result in reddening of the eyes although it tends to be considerably more pronounced in the infectious version (also known as pink eye).

Viral conjunctivitis will go away on its own within one to two weeks (days three to five tend to be the worst) and can only be treated by minimizing its symptoms through the use of over-the-counter eye drops that contain decongestants and antihistamines.

Bacterial conjunctivitis can be treated by antibiotic eye drops. There is an over-the-counter version known as Polysporin that works most of the time, and numerous prescription versions that should remedy your ailment within a few days of starting.

Allergic conjunctivitis is usually (85 per cent of the time) associated with nasal symptoms as well, and is far more commonly associated with seasonal allergies rather than perennial ones.

The first steps in treatment are minimizing your exposure. These measures include using cold compresses (which will also help with the redness) rather than rubbing your eyes when they get itchy, keeping windows and doors closed on high-pollen days, finding someone else to mow your lawn, wearing close-fitting sunglasses while outside, frequent washing of your hands and face (particularly when you come in from the outside), and at least rinsing off your hair before retiring for the night.

Contact lenses should be removed as well. Artificial tears are a safe and inexpensive way to dilute and wash away allergens from the eyes.

If these measures prove insufficient, there are a variety of both prescription and over-the-counter eye drops that can help relieve any residual symptoms. Adverse reactions to any of these options tend to be mild and short-term and can include eye irritation, headache, taste disturbance, dry eyes and blurred vision.

Contact lenses should be removed before using any of the options and a period of at least 10 minutes should expire before reinserting them.

The over-the-counter options include products that contain both a decongestant and an antihistamine, such as Opcon-A or Refresh Eye Allergy Relief.

Advantages are ease of access (no physician visit required), price, and onset of action (within a few minutes to hours).

Disadvantages include that they should not be used for prolonged periods of time (no more than a week and some recommend four days or less due to loss of effectiveness and the potential for rebound symptoms upon discontinuation), they need to be applied multiple times a day (usually four), they are often not approved for young children (this varies by the ingredient so refer to the package or your pharmacist), and they cannot be used by those with glaucoma and are used with caution in those affected by high blood pressure, heart disease or an enlarged prostate.

The other over-the-counter product is Cromolyn (Opticrom). It is a mast cell stabilizer. It can be used continually for persistent symptoms but takes two to three days to kick in and tends to work better when used four times a day continually throughout the allergy season which is not overly convenient.

Of the prescription options, the favoured choices tend to be the drops that combine an antihistamine with a mast cell stabilizer, such as Pataday, Bepreve, and Zaditor. They all reduce itchiness within minutes (although their full benefits can take up to two weeks to be seen) very effectively, can be used continuously throughout the season, are safe in children as young as age three, and have to be administered only once or twice per day depending on the product.

At this point there is no clear evidence as to which one works best and all are safe to use in the patients who must use the over-the-counter options listed earlier with a degree of caution.

Should these options not prove adequate, other less-commonly-used drops include Alomide (a mast cell stabilizer) and Alocril (also a mast cell stabilizer but also exhibits anti-inflammatory effects).

Finally, for persistent symptoms that do not respond to any of these, a corticosteroid eye drop can be tried for up to 10 days. One of the preferred options is Alrex since it is less likely to increase the pressure within the eye than the other steroid drops.

It is highly effective and very quick-acting but its use should be limited by its association not only with the increased eye pressure but also the risk of causing cataracts, glaucoma and eye infections.

Not to be forgotten, regular allergy pills (Claritin, Reactine, etc.) and/or immune therapy (either shots or pill equivalents such as Grasstek) can also provide significant relief of eye symptoms, as well as their nasal counterpart.

For more information about this or any other health-related questions, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination. Also check the website at www.gordon-pharmasave.com/ and the Facebook page at www.facebook.com/GordonPharmasave/?fref=ts