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Dry Eyes or Allergies: Which do I Have?


Dry Eyes or Allergies: Which do I have?

As an eye doctor, diagnosing a red eye can be challenging.  Are we dealing with an infection, allergy, inflammation or dryness? One of the most common questions I get is, “Doc, my eyes are red, burning, itchy, and tearing. Is this dry eye or from allergies?” The short answer is it could be one, both or neither. Below I outline various ways both of these conditions present clinically and the treatments for them.

The hallmark symptom of allergy – meaning if you have this symptom you almost definitely have the condition – is itching. Red, watery, ITCHY eyes are almost invariably due to an allergen, whether environmental or medicinal in nature (Ocular Allergies at the Jersey Shore). It is one of the most common ocular conditions we, as eye doctors, treat especially when plants are filling the air with pollen as they bloom in the spring and then die off in the fall.  The itching occurs because one of immune cells called a Mast cell releases histamine causing the itching sensation.  It can be quite unbearable for the sufferer, causing them to rub their eyes constantly, which unbeknownst to them, actually increases the amount of histamine in the eye leading to worsening of the symptoms. Treatments may include: over the counter or prescription allergy drops (mostly anti-histamines or mast cell stabilizers), topical steroids (to get the inflammation under control), and cool compresses applied to the eye. Sometimes, patients need to take drops every day to keep their symptoms under control.  

Dry Eye can have many of the same symptoms as allergic eye disease with the eye being red and possibly watery (My eyes are tearing how could it be dry eyes?).  The main exceptions are that people with dry eyes tend to complain more of burning and a foreign body sensation (like there is sand or gravel in the eye) rather than itchiness.  Dry eye is a multi-faceted disease with many different causes and treatments  which is part of the reason we have developed the Dry Eye Center here at Shore Eye Associates. Treatment ranges from simple re-wetting eye drops to long-term medications (both topical and oral), as well as non-medicinal treatments such as eyelid heating treatment.

So how do we determine the difference? The first question I ask patients who complain of red, watery, uncomfortable eyes is, “What is your MAIN symptom? Itching or burning?” The answer will likely direct which course of treatment we take, and as sometimes those treatments overlap, and you may have a component of both Dry Eye and Allergy.  That is important to distinguish because many of the treatments we use for allergies like antihistamine eye drops can sometimes make the dryness worse.   Though neither of these conditions is 100% curable (except maybe for allergy, where if you remove the allergen, you obviously won’t get symptoms!)  We have many tools in our treatment arsenal to keep the symptoms at bay. 

Unfortunately, Dry Eye and Allergy aren’t the only two things that can cause your eye to have the multiple symptoms of red, watery, itchy, burning eyes (Red Eye should I go to the Emergency Room?).  There are other problems which can produce a similar appearance like Blepharitis (what can I do for my red itchy eyelids?) and bacterial and viral infections (not every red eye is “pink eye”) so before embarking on a particular therapy (Is it safe to use a “redness relief” drop every day?) it is wise to have a good exam to help you get on the right track of improving your symptoms.

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Friday, 21 January 2022

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