Dear Alice:

Like many others during this season, I have been suffering from allergies for the past week or so. I have the usual indications such as runny nose, sneezing, and watery eyes. I have been taking over-the-counter medicine, and it seems to work well for sneezing and runny nose. However, I often find my eyes very itchy and watery. It bothers me a lot since I need to study. But, with my irritated eyes, it is sometimes difficult to read for a long time.

Do you know of any medicine that would help me? Also, sometimes I wash my eyes with cold water when they bother me. It seems to help a little, but does not last very long. Do you recommend using eyedrops like Visine?

Signed,
Suffering from allergies

Dear Suffering from allergies,

Sorry to hear about your optical suffering! You're on a helpful track with cold compresses and seeking over-the-counter (OTC) medications for eye allergies. Artificial tears or lubricating eye drops can provide relief from seasonal allergies, and you may want to try several different types to find the one that works best for you. Those with seasonal eye allergies usually find relief as the seasons change. In the meantime, there are a number of different over-the-counter and even prescription eye medications that may ameliorate your suffering. It may behoove you to try out different OTC options to see if any of them work for you, before considering prescription eye medications. 

So what causes these itchy, watery eyes? Seasonal allergic conjunctivitis (SAC) is otherwise known as the common seasonal allergy. Ocular (eye) allergies that accompany this seasonal affliction happen when the conjunctiva, a clear layer of skin overlying the eyes, becomes irritated by a host of possible irritants. This includes pollen, weeds, grass, dust, pet dander, perfume, and cigarette smoke. When this irritation occurs, the cells in the eye react by releasing histamine. It's the histamine that causes the symptoms you mention — having itchy, watery eyes — since it causes blood vessels to dilute, as well as leak. This also explains why antihistamines are so helpful in relieving ocular allergy symptoms. It's also worth noting that the clear layer of skin on the eyes that gets irritated is the same type of skin as inside the nose, which is why nasal and eye allergies often come at the same time for many folx — whatever allergen is disrupting your nose is likely to cause problems for your eyes as well.

One way to relieve these allergies may be through OTC eye medications, which include:

  • Tear substitutes, which can temporarily wash allergens from the eyes, and hydrate eyes that are dry from irritation
  • Decongestant or combination decongestant-antihistamine eye drops with active ingredient tetrahydrozoline or naphazoline

Many decongestant or combination decongestant eye drops must be used several times a day in order to alleviate symptoms of seasonal allergies. This is because the ingredients serve to constrict blood vessels, lessening symptoms. This typically offers short-term effects, and when used too often, can cause hyperemia — the excess of blood in blood vessels — which may actually exacerbate symptoms of allergies. Products such as this are only intended to be used a maximum of four to six times a day for no more than two weeks. Prescription-strength medications may more powerfully alleviate itchy, watery eyes. Prescription eye medications for allergies that have proven to be most effective include:

  • Antihistamine eye drops with active ingredients levocabastine and emedastine
  • Mast cell stabilizer eye drops with active ingredients lodoxamide, olopatadine, and sodium cromoglycate, with lodoxamide being the most effective

Antihistamines typically relieve symptoms within minutes, and mast cell stabilizers take about one to two weeks to start working. This is because over time, mast cell stabilizers ultimately prevent histamine from being released in the first place. Newer eye drops combine both antihistamines and mast cell stabilizers and can be used twice a day for quick and long-lasting relief. A conversation with your health care provider can help you decide what specifically may be right for you.

In conjunction with trying OTC medications or seeking prescription options, there are several steps you can take in your home that may help prevent allergies from worsening, despite what’s blooming outside. Some of these tips may pertain more to those managing indoor allergens such as dander or mites. Because eyes are such a sensitive organ, you may find these adjustments helpful to you, too:

  • Reduce clutter wherever possible that can collect dust, such as excess bedding or draperies and household knickknacks.
  • Clean regularly and thoroughly to remove dust that may irritate the eyes.
  • Use allergen filters in your air conditioning and heating units if possible.
  • Try to keep outdoor allergens outside and away from your eyes — keep windows and doors closed and make sure they are properly insulated.
  • Consider wearing glasses or sunglasses whenever outside as a way of reducing contact between potential allergens and your eyes.
  • Resist the urge to rub or scratch your eyes as much as possible.

If these tips aren't producing 'health-eye' results and OTC solutions just aren't working, you may want to talk with your health care provider about how to treat your symptoms.

Best of luck in seeking optimal optical relief!

Alice!

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