The inside of the eyelids and the surface of the eye respond to irritation by becoming red and swollen with tearing and mucous discharge. If the irritant produces release of immune cells, the reaction is called an allergic process and is accompanied by itching. One person might be more sensitive than another to certain irritants or allergens. One person might be more sensitive at one time than another. That is why there is such a variation in allergic reactions.

There are several degrees of allergic response of the eyes. Treatment is directed to the degree of response with the purpose of providing relief in the simplest, safest, most convenient and cost effective manner.

Redness and itching on some days, with minimal tearing, mark the initial allergic response. Seasonal presentation is common. Nose irritation and sneezing may accompany the eye symptoms. Treatment is cool or cold compresses to prevent rubbing. A damp cloth kept in a plastic bag in the refrigerator is an easy way to provide cool compresses. An antihistamine/decongestant eyedrop also is helpful. There are many brands available over the counter; all of them end with an “A” at the end. Some examples include: Vasocon A, Naphcon A, Albalon A or Visine AC.

Mid levels of allergic response presents with daily itching and burning of the eyes, excess tearing and redness, worse in the afternoons. Some degree of light sensitivity is common. Treatment is the cool compresses as above and a daily drop to prevent the release of the allergic chemicals inside the eyelids. The drops must be used on a regular basis to prevent the release of these chemicals inside the eyelid. It takes several days for the effect of the drop to build up. The effect disappears when the drops are stopped. Drops should be continued until a seasonal change of climate. Examples of such prescription medications include: Patanol, Acular, Alocril, Livostin, Opticrom, Zaditor and Optivar.

Severe degrees of reaction cause changes in the structures of the eyelids and can be sight threatening. These reactions are treated with prolonged topical steroid medicines and systemic medicines. A severe form, TENS or Steven Johnson syndrome, can affect all parts of the body and is life threatening in severe cases. Prolonged use of topical steroids carries risks of glaucoma, cataracts and visual loss.