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Month: March 2019

Itchy, Red Eyes: Allergy or Infection?

The most common cause in the Washington, DC, Northern Virginia, and Maryland metropolitan area for itchy, red eyes in the Spring and Fall high pollen seasons is inflammation of the thin membrane covering the eyeballs (i.e., conjunctivae).  This inflammation is triggered by allergen exposure to susceptible individuals.   However, inflammation to the conjunctivae can also be caused by infections by microorganisms such as viruses, bacteria, and rarely fungi and parasites.

It is very important for a board certified allergist to distinguish the difference between these two conditions as the treatment options are determined by the causative factors and differ greatly.

Though it is not always possible to differentiate the conditions by symptoms alone, the following information can be a helpful beginning.itchy eyes

If the discharge from the eye(s) is anything more than normal tears, it is more likely to be something more than allergies.  Though allergies also can cause much discomfort, pain in the eye(s) is more indicative of an infectious process.

A definitive diagnosis can only be made by examination and testing by trained and experienced professionals.

Allergies are not contagious to others but infections can easily spread from person to person or from one eye to the other eye.  The signs and symptoms of eye allergies (i.e., allergic conjunctivitis) are more likely to occur in both eyes, whereas infections are more likely to develop in one eye initially, although both eyes may be affected.


Prevention and Treatment:

Allergic Conjunctivitis:

Prevention should include reducing one’s exposure to known allergens by restricting outdoor activities on high pollen days, keeping windows closed, keeping pets out of the bedrooms, and using air purifiers and dehumidifiers to minimize dust mite and mold growth.

Treatment involves using over-the-counter eye drops containing antihistamines and mast cell stabilizers.  These are often helpful in relieving the itching and redness that are characteristic of allergic conjunctivitis.  They can be supplemented with oral medications (e.g., antihistamines) especially if nasal and sinus symptoms are also present.  Over-the-counter artificial tears also can help keep eyes moistened and flush out allergens.  In case of persistent symptoms, certain nasal corticosteroids, but not all, have the indication to help alleviate the allergic eye symptoms that may be extremely bothersome to the allergic individual.  Though they are more efficacious, the risks of adverse effects are also higher.

Allergy shots (i.e., allergy injections, allergy immunotherapy, allergy desensitization, allergy hyposensitization) is very effective in treating individuals with allergic conjunctivitis whether they have associated hay fever (i.e., allergic rhinitis) or not.

Infectious Conjunctivitis:

Prevention should entail avoiding exposure to people battling viral and bacterial infections to the best of their ability.  In addition, frequent hand washing can reduce the risks of contracting and spreading infectious eye conditions.

The treatment of infectious conjunctivitis varies depending on the microorganism.

Most viral infections resolve after a few days without any specific antiviral medications.  Lubricating eye drops and cold compresses can help relieve the discomfort and facilitate recovery.

Bacterial infections need antibiotic eye drops, instilled several times a day for about a week in order to treat the infections.  Rarely infections can also be caused by fungi and/or parasites.  In these rare cases, anti-fungal and anti-parasitic medications can be administered.

If eye infections are mistakenly self-treated with over-the-counter allergy medications, one can run the risk of damaging the eyes.

Other Ocular Allergies:

Of note, there are 3 other forms of ocular allergies that are more severe than allergic conjunctivitis which include the following:

Vernal keratoconjunctivitis (VKC):  A chronic inflammatory swelling of the outer lining of the eyes due to an allergic reaction.  It typically affects boys and young males who live in hot dry climates in a seasonal manner, most often occurring in the Spring and/or Summer.  It usually occurs in patients with a family history of allergies.  The classic symptoms may include watery eyes, itching, redness, and/or increased sensitivity to light (i.e., photophobia) of both eyes.  The treatment is similar to that of allergic rhinitis (see below), but in addition, individuals with severe cases may need topical corticosteroids, cyclosporine, or tacrolimus.  Rarely, oral corticosteroids may be necessary in recalcitrant cases.  It should be noted that rarely, VKC can lead to corneal scarring and vision loss if not properly treated.

Atopic keratoconjunctivitis (AKC):  A genetic disorder that is more common in adults (men more than women) where the immune system produces higher amounts of antibodies in response to a given allergen.  Although AKC is perennial in nature, the symptoms may worsen in the Winter.  Individuals usually have a history of eczema (i.e., atopic dermatitis).  The typical symptoms may include red eyelids, burning, itching, watery eyes, and/or increased sensitivity to light (i.e., photophobia) of both eyes.  The treatment is similar to that of VKC.  It should be noted that rarely, AKC can lead to corneal scarring and vision loss as mentioned above with VKC.  This complication however occurs more often in individuals with AKC than with VKC.

Giant papillary conjunctivitis (GPC):  A disorder that causes inflammation in the inside part of the eyelid.  It is most often caused by a reaction to eyelid movement over a foreign substance such as contact lenses.  It can develop at any time after wearing contact lenses.  An allergic reaction is thought to be one of the causes of GPC.  Some individuals are allergic to either their contact lenses or the chemicals used to clean them.  An allergic reaction between the skin of the eyelid and the contact lenses or chemicals may be a cause.  Other causes of GPC may include repetitive rubbing of the eyes, eye implants, and/or sutures in the eyes from a previous eye surgery.  The symptoms may include watery eyes, redness, burning, itching, and/or pain.  Treatment includes changing one’s contact lens regularly and limiting the time of wearing them to a few hours per day.  Disposable contact lenses may be of some benefit as well.  In more severe cases, the individual should stop using contact lenses altogether.

The board certified allergy specialist physicians at Black and Kletz Allergy have over 50 years of experience in diagnosing and treating all types of eye conditions whether allergic or infectious.  We treat both pediatric and adult patients.  Black & Kletz Allergy has 3 convenient locations with on-site parking located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  The Washington, DC and McLean, VA offices are Metro accessible and we offer a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line.  To schedule an appointment, please call any of our offices or you may click Request an Appointment and we will respond within 24 hours by the next business day.  We have been servicing the greater Washington, DC metropolitan area for many decades and we look forward to providing you with the utmost state-of-the-art allergy care in a welcoming and pleasant environment.

Tree Pollen Allergies

Tree Pollen Washington DCIn the Washington, DC, Northern Virginia, and Maryland metropolitan area, tree pollen usually begins to pollinate in mid-February.  The pollination is usually dependent upon the weather such that towards the end of Winter, when it first becomes warm outside, pollen begins to be released from the trees.  Depending on the temperatures, tree pollination can occur as early as early February or as late as early March.  When the trees produce their pollen, allergy sufferers are usually the first to know because they typically will develop symptoms of hay fever (i.e., allergic rhinitis) and/or asthma.  As we approach Spring (late March), the tree pollen counts rise and so do the symptoms of individuals with tree pollen allergies.  In the Washington, DC metro area, tree pollen counts continue to rise and generally peak in April.  This milestone is usually recognized by millions of people as they become aware that all of the cars appear “yellow” in color.  The yellowish color of the cars is due to the yellow-colored tree pollen falling on and sticking to the numerous motor vehicles that dominate the DC metro area.  The tree pollen count will then decrease and usually end by the end of May.  Note that as tree pollination decreases, grass pollination begins.  Grass pollen is also a major allergen in many allergic individuals.

It is noteworthy to mention that most people in the DC metro area, who are unfamiliar with allergies, think that it is the cherry trees that are causing their allergy symptoms.  This fallacy is believed and propagated because people with tree pollen allergies usually feel miserable around the same time that the cherry trees in the Washington, DC area begin to bloom.  What most people do not realize is that in general, flowering trees and plants do not cause allergic symptoms for the most part.  The reason for this is that individuals who suffer allergy symptoms from tree pollen need to breathe in the pollen in order to develop the typical symptoms of hay fever.  The pollen of flowering trees and plants is heavy compared with non-flowering trees.  The lighter pollen found on non-flowering trees (e.g., birch, cedar, elm, ash, beech, hickory, maple, oak) are wind-dispersed.  These pollens will travel in the air for hundreds of miles sometimes in order to settle on other trees which will cause the trees to continue to reproduce.  With flowering trees and plants, since the pollen is heavy, wind will not suffice to spread the pollen.  In order to reproduce, the pollen on flowering trees and plants require the aid of bees, hummingbirds, moths, butterflies, beetles, etc. to land on the flowers to help with the cross-pollination.  For example, a bee will be attracted to a flower and as it lands on the flower, the tree pollen sticks to its abdomen.  When the bee then lands on another flowering tree or plant, the pollen is transferred to that flower and cross-pollination occurs which allows further reproduction.  An easy way to think of it is as follows:  It is the pollen of the “ugly” trees that are wind-dispersed and thus cause allergies.

The symptoms that individuals generally experience with tree pollen allergies may include one or more of the following:  sneezing, runny nose, nasal congestion, post-nasal drip, itchy nose, itchy eyes, watery eyes, redness of the eyes, itchy throat, itchy ears, clogged ears, sinus pressure, headaches, snoring, fatigue, wheezing, chest tightness, coughing, shortness of breath.

The diagnosis of tree pollen allergies can be made by seeing a board certified allergist such as the ones at Black & Kletz Allergy.  A comprehensive history and physical examination are obtained and then usually allergy testing is performed in order to identify an allergy to a specific allergen (e.g., tree pollen).  Allergy tests can be done by either skin testing or blood testing, although skin testing is generally the preferred method.

Once an individual is diagnosed with tree pollen allergies, avoidance measures are discussed, although the goal of allergy treatment is to allow the person to enjoy their hobbies (e.g., gardening, golf, hiking) rather than being restricted to being indoors for 3 months every Spring.  In addition, there are numerous medications that an allergist can prescribe in order to help alleviate the unwanted allergy symptoms of the allergy sufferer.  These medications come in the forms of tablets, syrups, nasal sprays, eye drops, lung inhalers, and injections.  If an individual has additional allergies such as grasses, weeds, dust mites, molds, pets, etc., then allergy shots (i.e., allergy injections, allergy immunotherapy, allergy desensitization, allergy hyposensitization) may be recommended.  Allergy shots are effective in 80-85% of the patients that take them.  They have been used in the United States for more than 100 years.  They are given to little children as well as older adults.  The average person is on allergy shots for 3-5 years.

If you think that you may have tree pollen allergies, or any other type of allergy, the board certified allergists at Black & Kletz Allergy would be happy to help you.  We have 3 convenient offices in the DC metro area with office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All of our office offer on-site parking.  Our Washington, DC and McLean, VA locations are Metro accessible.  There is also a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line.  Please call us for an appointment.  Alternatively, you can click Request an Appointment and we will respond to your request within 24 hours by the next business day.  The allergists at Black & Kletz Allergy have been treating both adults and children in the Washington, DC metropolitan area for allergies, asthma, sinus disease, and immunologic disorders for more than 50 years.  We strive to provide top-of-the-line allergy relief in a caring and professional environment.