What is allergic pink eye?

Close up of a brown eye with allergic conjunctivitis, it is watery and sore

Symptoms of allergic pink eye can be very unsettling, especially if you’ve only recently developed it. The conjunctiva is a protective film that covers the inner eyelid and white part of the eye. When it becomes inflamed, red and watery you have conjunctivitis or pink eye.

If you have allergic pink eye, allergens, such as pollen or dust mites could be causing the symptoms. Not bacteria or viruses. So it can’t spread from one person to another, in other words it’s not contagious pink eye. Either way, it’s important not to touch or rub your eyes as this could irritate them more.

In this article we discuss the symptoms and causes of allergic pink eye. Later we talk about how allergic pink eye is diagnosed and treated.

What are the symptoms of allergic pink eye?

Symptoms of pink eye can differ depending on if it’s caused by allergies or a viral or bacterial infection. However, overlapping symptoms include itching, red and watery eyes.

If you have allergic pink eye, both eyes are normally affected and are usually bloodshot. You may also experience intense itching in or around the eyes. Other symptoms can include a runny nose. Generally, this means you’re experiencing an allergic reaction rather than a bacterial or viral infection. Usually, initial symptoms, such as watery discharge and redness of the eye appear within 20–30 minutes of encountering the allergen.

Because there are different types of allergic pink eye, some people can experience additional symptoms, including:

  • Eye pain (burning eyes or a stinging sensation)
  • Blurred vision
  • Swollen eyelids
  • A gritty feeling in the eye (foreign body sensation)
  • Light sensitivity (photophobia)
  • Corneal ulcers
  • Lumps and swelling on the inner eyelids

With bacterial conjunctivitis you may notice a more yellowish-white discharge and that your eyelids are very sticky. Sometimes your eyelids may even stick together. This is likely to happen in the morning when you first wake up. Viral conjunctivitis shares similar symptoms but typically has watery discharge instead. Some viruses that cause pink eye are spread by mosquito and tick bites, so it’s important to take care when travelling to tropical or subtropical regions.

If you’re also experiencing a headache or feel nauseous you should see a healthcare provider so they can rule out more serious conditions.

Causes of allergic pink eye and the different types

Regardless of the type of allergic pink eye you have, the underlying cause always involves the immune system.

The different types of allergic pink eye are:
Seasonal allergic conjunctivitis Perennial conjunctivitis

People may experience symptoms whenever they encounter their trigger pollen, for example tree or grass pollen. Sometimes it’s referred to as hay fever conjunctivitis.

Occurs all year round and is triggered by dust mites, animal dander (fur), feathers, mold spores and cockroaches. People can experience symptoms more frequently as they get older.

Vernal keratoconjunctivitis Atopic keratoconjunctivitis

This type of allergic pink eye is more common in males between three to 25 years old, who have asthma or eczema. Exposure to wind, dust or bright sunlight can make symptoms worse. It’s also more widespread in warmer climates.

People with eczema may typically experience this form of allergic pink eye. It’s also more common in males and can run in families. Some people may also develop atopic dermatitis in the eyelids or have hyperpigmented (darker) skin around the eyes.

Giant Papillary Conjunctivitis

Allergic pink eye symptoms could develop when a foreign body repeatedly rubs against the eye and eyelid. Examples of foreign bodies are contact lenses, artificial eyes and stitches. Usually, the object has an allergen on its surface.

In seasonal and perennial conjunctivitis, the immune system confuses harmless particles for bacteria or viruses. Because of this, it then creates specific immunoglobulin E (IgE) antibodies to target and destroy them. So, the next time a bit of pollen or animal dander lands on your eye, the IgE antibodies activate and cause other cells to release different chemicals, including histamine. This is what causes allergic pink eye symptoms.

With other types of allergic pink eye, a range of immune cells are sometimes activated. However, with vernal keratoconjunctivitis researchers are still investigating why some people develop it when others don’t.

How long does allergic pink eye last?

If you’re allergic to tree pollen you’ll likely notice symptoms easing on their own when the tree pollen count is low. Yet with other types of allergic pink eye, conjunctivitis symptoms can persist all year round, unless you receive treatment. Especially if they’re caused by indoor allergens or a foreign object, for example contact lenses.

How do healthcare providers treat allergic pink eye?

No matter what type of allergic pink eye you have, on your first meeting your healthcare provider will likely talk about how to practice eye care to reduce symptoms.

Typical eye care advice includes:

  • No eye rubbing
  • Using artificial tears (lubricating eye drops)
  • Applying a cold compress to the eyes
  • Avoiding trigger allergens

They may also suggest taking over-the-counter antihistamines as an initial treatment option. Particularly for when you can’t avoid allergens or irritants. Don’t forget, that anything in the eye can irritate it. So, if you usually wear contact lenses and they're causing eye redness and other symptoms, try to wear glasses instead.

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Sometimes your symptoms may persist. And when this happens, your healthcare provider may refer you to a specialist who will investigate your allergy further. If your allergic pink eye is severe, they may prescribe corticosteroids or medication that suppresses your immune system.

Allergy immunotherapy could also be an option for some people.  This type of treatment aims to retrain your body to get used to the allergen that’s causing symptoms. Over a period of time, you’re given controlled and repeated doses of the allergen. Its goal is to target the cause of the allergy, not just the symptoms.

This option is only available to people whose allergies are caused by IgE antibodies, so may be more suited to people with seasonal and perennial conjunctivitis.

How is allergic pink eye diagnosed?

Before a healthcare provider diagnoses you with allergic pink eye, they’ll most likely ask you questions about your health history. They do this to narrow down any potential allergens you’ve encountered. Additionally, they’re also making sure you don’t have viral pink eye or bacterial pink eye.

To confirm if any allergens are causing your pink eye symptoms, they might recommend a skin prick test or patch test. Sometimes the results suggest more than one allergen could be responsible. When this happens, you may need to undergo a conjunctival allergen provocation test (CAPT). This is also called a conjunctival allergen challenge (CAC).

During this test, increasing amounts of the suspected allergen, for example pollen, are applied to the eye. If you begin to feel any symptoms, such as itching or tearing up you likely have an allergy.

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