Dry Eyes from Allergies? Here is What You Need to Know

Dry eyes caused by allergies are a common and often overlooked discomfort. People with allergies often develop symptoms that mimic dry eye syndrome. Thus, making it crucial to differentiate between the two. Do you want to know the causes, symptoms, diagnostic methods, treatments, and preventive strategies for allergic dry eye in greater depth? Read on.

Allergies Trigger Dry Eyes

Dry eye syndrome, keratoconjunctivitis sicca, is when the eyes either don't produce enough tears or they evaporate too quickly. The result is discomfort, irritation, and inflammation. Allergies tend to worsen dry eye symptoms by disrupting the tear film, increasing dryness and itching.

When a person with allergies encounters pollen, dust mites, or pet dander, the immune system overreacts, releasing histamines and inflammatory chemicals.

The natural body's reaction shows as:

• Quick tear evaporation

• Low tear production

• Eye irritation

The meibomian glands are affected, reducing the oily layer of the tear film, and causing fast tear evaporation. Some allergens or medications (e.g., antihistamines) can decrease tear secretion. Allergic conjunctivitis comes with redness, itching, and a burning sensation. Signs, which may be mistaken for or exacerbate dry eye syndrome.

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Causes of Allergic Dry Eye

Several factors contribute to dry eyes linked to allergies:

1. Environmental Allergens

• Pollen

• Dust Mites

• Pet Dander

• Mold Spores

Common in seasonal allergies (hay fever), pollen may irritate the eyes and cause excessive tearing followed by rebound dryness. Dust mites are microscopic creatures that thrive in bedding, carpets, and upholstery, leading to chronic allergic reactions. Proteins in pet saliva, fur, and skin flakes can trigger excessive responses as well. Last but not least, found in damp environments, mold worsens eye allergies and inflammation.

2. Medications

• Antihistamines & Decongestants

• Beta-Blockers

• Isotretinoin (Accutane)

It sounds odd that allergy medications and decongestants could worsen dry eye from allergies. These are often used to control allergy symptoms but can, in fact, also reduce tear production. Used for blood pressure or glaucoma treatment, beta-blockers do the same thing. As for Isotretinoin (Accutane) used for acne, it often causes severe dry eyes as a side effect.

3. Contact Lenses

Wearing contacts for extended periods or wearing them to sleep leads to protein and allergen buildup. The buildup leads to eye irritation and exacerbates dryness and foreign body sensation.

4. Environmental Conditions

• Wind & Smoke

• Air Conditioning & Heating

• Screen Time

Outdoor exposure, cigarette smoke, and air pollution strip the eyes of moisture. AC and heating systems lower indoor humidity, accelerating tear evaporation. And of course, prolonged digital device use reduces blink rate and makes eyes dry and itchy.

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Symptoms of Allergic Dry Eye

Allergic dry eye symptoms often overlap with traditional dry eye syndrome. The difference is in the itching and other allergy-related issues. Some common symptoms to look out for are:

1. Itching

2. Redness

3. Burning or Stinging Sensation

4. Watery Eyes

5. Blurred Vision

6. Swollen Eyelids

When you're allergic to something, your body releases a chemical called histamine. Histamine is what causes the itching, as it makes your nerve endings extra sensitive, so they send signals to your brain that make you feel itchy.

Itching is a hallmark symptom of allergies, often accompanied by a strong urge to rub the eyes. As for redness, it's an inflammation of the conjunctiva due to histamine release. The stinging and burning feeling comes from higher eye sensitivity and tear film instability.

Watery eyes are a reflex tearing due to irritation. Yet, these tears lack the necessary oil content, worsening dryness. Also, tear film instability may present as fluctuating vision clarity. Allergy-related inflammation may provoke puffiness around the eyes.

Allergic Dry Eye Diagnosis

A proper diagnosis distinguishes between allergic conjunctivitis, dry eye syndrome, and other conditions.

1. Medical History and Symptom Analysis

The doctor will ask about the timing of symptoms, triggers, and environmental factors. Medication use, seasonal allergies, and contact lens wear will be considered, too. So feel free to share everything you think might be relevant to your case.

2. Eye Examination

Expect a slit lamp examination and fluorescein or lissamine green staining. The slit lamp exam assesses the eye surface, looking for tear film instability or redness. Fluorescein or lissamine green staining identifies damaged cornea areas due to dryness.

3. Allergy Testing

Skin prick tests or blood tests determine specific allergens causing eye irritation. If the cause of the allergic dry eye is unknown, these types of tests will give you answers.

4. Tear Film Testing

As a last test, you may need tear film testing. Schirmer’s test measures tear production by placing a small strip of filter paper under the lower eyelid. Then tear break-up time (TBUT) evaluates how quickly tears evaporate after blinking.

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Treatment Options for Allergic Dry Eye

Managing allergic dry eye necessitates treating allergies and supporting tear production. Different treatment options will work differently for each person. You may need to try a few things with the guidance of an eye doctor, to find what best works for you.

Artificial Tears

Artificial tears are the best solution for people with dry eyes. Preservative-free drops are best for frequent use to avoid irritation. If you have extreme irritation and need longer-lasting relief - choose artificial gels or ointments.

Antihistamine Eye Drops

Antihistamine eye drops reduce allergic inflammation and dryness. Ketotifen, Olopatadine, and Azelastine are common active ingredients in these eye drops. Other options with mast cell stabilizers prevent the release of histamines. Thus reducing long-term allergy symptoms.

Prescription Medications

Certain prescription medications can manage allergic dry eye symptoms:

• Corticosteroid eye drops

• Immunomodulators

Corticosteroid drops reduce severe inflammation but could have side effects if used for a long period. Other medications, such as Cyclosporine (Restasis) or Lifitegrast (Xiidra), encourage your eyes to produce more natural tears and control inflammation long-term.

Always ask your eye doctor how often and for how long you should use your eyedrops.

Preventive Measures for Dry Eye from Allergies

Allergic dry eye aids a proactive approach to minimize allergen exposure:

• Keep windows closed during high pollen seasons

• Wash hands and change clothes after outdoor exposure

• Use allergy-proof covers on pillows and mattresses

• Wear sunglasses to shield the eyes from wind, pollen, and UV rays

• Use a humidifier at home to stop excessive tear evaporation

• Use air purifiers indoors to cut down on pollen, dust, and pet dander

• Install HEPA filters in your purifiers to capture tiny particles from the air

• Clean the eyelids a few times a day to remove allergens and bacteria

• DON'T rub your eyes - rubbing worsens the condition by releasing more histamines

When to See a Doctor

If symptoms persist despite treatment you should go see an eye doctor. Other instances that urge medical attention are severe pain, noticeable vision changes, pus or unusual discharge, persistent redness, and eye swelling. Seek medical attention promptly to rule out infections or serious eye conditions.

External resources:

• Dry Eyes and Allergies: What to Know, WebMD

• What to know about dry eyes due to allergies, Medical News Today

✅ Medically reviewed

Checked by Atanas Bogoev, MD.