Allergy Related Eye Problems in Children

Allergy Related Eye Problems in Children


Eye-related conditions that affect children spring from many different causes, including allergies. Studies have found that a significant percentage of children with allergies will experience symptoms in their eyes and nowhere else.

On the other hand, redness, watery eyes and other symptoms are not always related to allergies. Sometimes, these symptoms indicate another disorder, such as a viral or bacterial infection or an immunologic disorder such as Kawasaki disease or uveitis.

Children may not always indicate that their eyes are bothering them. For this reason, parents should watch for certain physical or behavioral indicators of an underlying eye problem. Physicians will rely on information from parents as a crucial factor in accurately diagnosing a child’s eye-related condition.

About eye-related conditions & children

Eye-related conditions in children frequently are the result of allergies. Allergies affect the eyes because the mucous membrane covering the front of the eye and the inner eyelid (conjunctiva) contains an estimated 50 million mast cells. These are the cells that release histamine and other chemicals that trigger symptoms of an allergic reaction. Both indoor (e.g., pet dander, dust mites) and outdoor allergens (e.g., pollen, mold) can cause eye-related conditions.

Children experience many of the same eye-related conditions as adults. Some eye-related conditions, such as vernal conjunctivitis, affect children far more often than adults.

To form an effective treatment plan, a physician will need to accurately diagnose whether a child’s eye-related condition stems from an allergic or nonallergic source. Parents who can present an accurate and complete account of a child’s symptoms will greatly aid in this process.

Types and differences of eye conditions

Eye-related conditions can be divided into those that are allergy-based, and those that are nonallergic. A physician must distinguish between the two to make an accurate diagnosis and prescribe an effective treatment plan.

Allergic eye-related conditions that affect children include:

  • Allergic conjunctivitis. This is a hypersensitivity of the eye to certain allergens that may be seasonal or perennial (occurring throughout the year).
  • Vernal conjunctivitis. An eye allergy that affects children far more than adults. This is a condition that arises in the spring and summer and occurs at least twice as often in males as it does in females. It is suspected that allergies trigger the condition.

    Vernal conjunctivitis tends to flare in the spring and fall in dry, warm climates, but lasts year-round in some children. It usually disappears during puberty.

Nonallergic eye-related conditions that may affect children include:

  • Giant papillary conjunctivitis. Results from eye contact with a foreign surface, usually contact lenses.

  • Atopic keratoconjunctivitis. Frequently occurs in patients with eczema. Left untreated, it can lead to the formation of cataracts (a clouding of the lens of the eye) and, eventually, blindness unless removed surgically. This can affect children, but usually affects those ages 20 to 50.

  • Infectious conjunctivitis. Commonly known as “pink eye,” it is the result of a bacterial or viral infection. It is commonly found in children and usually does not present a major health threat.

  • Blepharitis. An infection of the eyelids that can cause a prolonged inflammatory response when combined with the overuse of eye drops. Most often affects adults, but can affect children, too.

  • Uveitis. Potentially sight-threatening swelling that may involve some or all inflammatory processes of the middle layers of the eye, also called the uveal tract or uvea. Usually affects adults, but the risk of blindness increases in children who have uveitis.

  • Kawasaki disease. An inflammation of the blood vessels in the body, including the eyes. This affects children exclusively.

Signs and symptoms in children

The symptoms that a child displays will vary depending upon the underlying condition afflicting the eye. However, there are several general signs and symptoms typically associated with eye-related disorders. They include:

  • Watery eyes. Eyes can water either because tear ducts are blocked, or because something is irritating them, such as an allergy.

  • Itchiness and burning. Histamine and other chemicals released during an allergic cascade produce these symptoms.

  • Redness. A healthy eye should have red blood vessels that are visible. However, chronic and excessive redness is a sign that the eyes are irritated, possibly by an allergy. Other factors, such as excessive coughing, also can cause this symptom.

  • Black circles around the eyes. Sometimes known as allergic shiners, they are the result of constant rubbing and scratching of the skin, which causes a darkening effect. This can be seen in children with allergic rhinitis (hay fever), as well as with other conditions.

  • Sensation that something is in the eye.

  • Cobblestone pattern of lesions on the conjunctiva under the eyelids.

  • Light sensitivity (photophobia).

  • Discharge. The characteristics of the discharge will vary based on the type of condition.

  • Swelling of the eyelid.

Symptoms of allergy-related eye conditions may occur alone or can appear in combination with nasal allergy symptoms (e.g., sneezing, sniffling, stuffy nose).

Children may not always indicate that their eyes are bothering them. For this reason, parents should watch for certain physical or behavioral indicators of an underlying eye problem. General signs of eye-related problems in children that require medical attention include:

  • Abnormal alignment of the eyes, or unusual eye movement after 6 months of age

  • Red-rimmed, crusted or swollen eyelids

  • Watery or red eyes

Children can also reveal potential eye problems through their behavior. Parents should watch to see if their child:

  • Rubs eyes often

  • Closes or covers one eye

  • Tilts head, or thrusts head forward

  • Struggles with reading or other work that involves close-up vision

  • Blinks more often than normal

  • Mentions that things are blurry or hard to see

  • Squints or frowns a lot while trying to see things

  • Has difficulty following (tracking) objects visually

Diagnosis methods in children

A physician will conduct a physical examination. Parents will be asked to provide information about the child’s medical history and list of symptoms. This information is crucial to helping the physician distinguish whether conjunctivitis is nonallergic or related to an allergy.

In evaluating a newborn, a physician will ask the parent for a full prenatal history. Likely questions include those about developmental delays, maternal infections (e.g., herpes simplex virus, chlamydia, human immunodeficiency virus [HIV]), and any complications with delivery. Some medications given to infants at childbirth, including silver nitrate (an ophthalmic antiseptic used to treat chlamydial infection) and erythromycin (an antibiotic), also are known to cause eye irritation.

When examining an older child, the physician will ask about potential exposure to individuals at home or in school who might have upper respiratory tract infections or conjunctivitis. In teens, a sexual history can potentially uncover the source of eye problems due to sexually transmitted chlamydial or neisserial infections. Questions about cosmetics or contact lens use also might reveal valuable information.

If nonallergic possibilities are ruled out and an allergy or allergic conjunctivitis is suspected, the physician will ask about environmental factors (including exposure to tobacco smoke, pets, carpets and drapes that collect dust, etc.) and time of onset (seasonal or perennial). Symptoms such as itchy eyes and stringy or ropy discharge are strongly indicative of an allergy diagnosis.

A physician may also request a vision check, observe a child’s eye motion, look for physical manifestations on the eyelids and test the reaction of pupils to light.

To confirm an allergy diagnosis, allergy testing also may take place.

Treatment options in children

There are a number of prescription and over-the-counter medications available to treat children with eye-related conditions. Often, eye symptoms can best be addressed by treatments that prevent or soothe allergic reactions. 

Many of these allergy drugs come in pill form. Children should not take any medications without first consulting a physician. Parents of children with eye conditions should consult a physician to avoid any potentially sight-threatening consequences of some eye conditions. In addition, overuse of some drugs can cause a rebound effect, which eventually makes symptoms worse instead of better.

Though some allergy medications are taken orally (including pills, chewables and liquids), others come in eye drops and can be directly applied to the eyes.  It is important to ensure that eye drop medication not only reaches the eye, but that it is fully absorbed so that the eye receives the maximum benefit of the drug.

Patients and/or parents of patients can also take other steps to relieve symptoms, including:

  • Parents can apply cold compresses to their child’s eyes to relieve symptoms. Cold acts as a mast cell stabilizer and vasoconstrictor. A child who rubs or scratches the eyes will only make symptoms worse by increasing histamine release.

  • Parents can use a saline solution or artificial tears to remove mucus or dilute allergens in the eye. Artificial tears can be very soothing to a child’s irritated eyes.

  • A child’s eyelid crusts can be removed by a parent softening them with warm compresses, and using a cotton applicator and baby shampoo to wash them away. 

If medications and avoidance do not arrest eye-related symptoms, allergy shots (immunotherapy) may be considered. Allergy shots are a form of allergy and asthma treatment in which low doses of an allergen are injected into a patient over a period of time. The goal is to increase the patient’s tolerance to the allergen while reducing symptoms brought on by an allergic reaction. 

Prevention methods for children

The best way to prevent children from experiencing eye-related symptoms due to allergies is to make sure they avoid the allergens that cause the symptoms. Tips for minimizing contact with allergens include:

  • Keep children indoors when pollen and mold counts are high.

  • Make sure the home is as allergen-free as possible. Using an air filter that can remove allergens from the air, such as a HEPA filter, may be beneficial.

  • Shower the child frequently to wash airborne allergens from their hair and skin.

  • Teach children to frequently wash their hands to reduce allergen contamination.

  • Tell children to wear sunglasses outside to protect the eyes from allergens.

  • Discourage children from rubbing their eyes because this will only irritate the eyes and make the condition worse.

Other steps may be necessary for those individuals who are susceptible to specific types of allergen triggers. For instance, children allergic to dust mites should have dust-proof encasements on their pillows, mattresses and box springs. Parents of children with pet-related allergies should remove the animals from the house, if possible, or at least keep the animals out of the bedroom.

Questions for your doctor

Preparing questions in advance can help parents to have more meaningful discussions with their child’s physicians. Parents may wish to ask their child’s doctor the following questions about eye-related conditions and children:

  1. How do I know if my child has an eye-related condition?
  2. What methods will you use to determine the cause of my child’s eye-related condition?
  3. What are my child’s treatment options?
  4. When can I expect my child’s symptoms to subside?
  5. Is my child’s eye-related condition contagious? 
  6. Is my child’s eye-related condition dangerous?
  7. Will the condition temporarily or permanently affect my child’s sight?
  8. When should I seek medical help for an eye-related condition?
  9. What types of eye-related conditions is my child most at risk for?
  10. What are some ways my child can avoid getting an eye-related condition?
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