ConditionEyes & vision
Allergic Conjunctivitis (Eye Allergies)
Allergic conjunctivitis is inflammation of the clear membrane covering the white of the eye and inner eyelids, triggered by allergens such as pollen, pet dander, dust mites or mold. The hallmark is itching, along with redness, watery eyes and puffy lids, usually in both eyes. It is not contagious. It often comes with hay fever sneezing and a runny nose. Avoiding triggers, cool compresses and antihistamine eye drops relieve most cases.
Also called: Eye allergies, allergic pink eye, hay fever conjunctivitis, seasonal allergic conjunctivitis
At a glance
- What it is
- Allergic inflammation of the conjunctiva, the thin lining of the eye and lids.
- Main symptom
- Itching, with redness, watering and puffy eyelids, in both eyes.
- Triggers
- Pollen, pet dander, dust mites, mold, cosmetics, contact lens solutions.
- Contagious?
- No.
- Treatment
- Avoid triggers, cool compresses, artificial tears, antihistamine or mast cell stabilizer drops.
When to get help
Call 911 or go to the ER
- Eye swelling with lip or tongue swelling, wheezing or difficulty breathing
See a doctor within a day or two
- Eye pain (not just itch), sensitivity to light, or blurred vision that does not clear with blinking
- Thick yellow or green discharge, or redness in only one eye with a contact lens wearer
- A red eye with a recent injury or chemical splash (rinse with water for 15 minutes first)
Book a routine appointment
- Symptoms that persist despite over-the-counter allergy drops for 1 to 2 weeks
- Year-round symptoms, or itching with large bumps under the upper eyelid
- Severe itching with eczema around the eyes in adults
Usually safe to manage at home
- Itchy, watery, red eyes in both eyes during pollen season or around pets, with clear vision
Symptoms
- itching, which is the most characteristic symptom
- redness of the whites of both eyes
- watery, clear discharge
- puffy, swollen eyelids, sometimes with a jelly-like swelling of the conjunctiva (chemosis)
- burning or gritty feeling
- sensitivity to light in some people
- often with sneezing, a runny or blocked nose and an itchy throat
Vision should remain normal. Dark circles under the eyes ("allergic shiners") are common in children.
Types of allergic conjunctivitis
| Type | Features |
|---|---|
| Seasonal | Spring or summer with tree, grass or weed pollen; the most common type |
| Perennial | Year-round, from dust mites, pet dander or mold; usually milder |
| Contact allergic | Reaction to eye drops, contact lens solution or cosmetics; eyelid skin often red and itchy too |
| Giant papillary conjunctivitis | Large bumps under the upper lid, mostly in contact lens wearers |
| Vernal keratoconjunctivitis | Severe, in boys and young men in warm climates; can affect the cornea |
| Atopic keratoconjunctivitis | Chronic, in adults with eczema; can threaten vision |
Vernal and atopic types need care from an eye specialist.
Allergic vs viral vs bacterial conjunctivitis
| Allergic | Viral | Bacterial | |
|---|---|---|---|
| Main symptom | Itching | Grittiness, burning | Sticky discharge |
| Discharge | Watery, clear | Watery | Thick yellow or green, lids stuck in morning |
| Eyes | Both | Often starts in one, spreads to both | One or both |
| Other features | Sneezing, hay fever, seasonal pattern | Cold symptoms, swollen gland in front of ear | Sometimes ear infection in children |
| Contagious | No | Yes, very | Yes |
See viral conjunctivitis and bacterial conjunctivitis.
Causes
When an allergen lands on the eye in someone who is sensitized, it binds to IgE antibodies on mast cells in the conjunctiva. These release histamine and other chemicals that cause itching, redness and swelling within minutes. People with hay fever, asthma or atopic dermatitis are more likely to have it.
Diagnosis
Diagnosis is usually based on symptoms and appearance. An eye doctor may examine the eyes with a slit lamp, look under the eyelids and check the cornea. Allergy skin-prick or blood tests can identify triggers if symptoms are persistent or severe.
Treatment
Avoid triggers
- During pollen season, keep windows closed, use air conditioning and check pollen forecasts.
- Wear wraparound sunglasses outdoors.
- Shower and wash your hair after being outside; change clothes.
- Keep pets out of the bedroom and use allergen-proof mattress and pillow covers for dust mites.
- Do not rub your eyes, which releases more histamine.
Soothing measures
- cool compresses on closed eyes
- refrigerated preservative-free artificial tears, which rinse allergens away
- take contact lenses out during flares, or switch to daily disposables
Eye drops
- Dual-action antihistamine and mast cell stabilizer drops such as ketotifen or olopatadine, available over the counter: the most effective first choice. Use regularly during the season.
- Antihistamine/decongestant combination drops (for example naphazoline with pheniramine): quick redness relief, but use for no more than a few days to avoid rebound redness.
- Prescription drops: stronger antihistamines, short courses of mild steroid drops under eye doctor supervision, or cyclosporine or tacrolimus for severe chronic forms.
Other treatments
- oral antihistamines such as cetirizine or loratadine, which help nose symptoms too but can dry the eyes
- steroid nasal sprays, which also reduce eye symptoms
- allergen immunotherapy (allergy shots or tablets) for people with severe, persistent allergies
Follow the label dose on over-the-counter products.
Frequently asked questions
How can I tell if pink eye is allergic or infectious?
Allergic conjunctivitis is very itchy, affects both eyes, causes watery discharge and often comes with sneezing or hay fever. Infections tend to cause grittiness or thick sticky discharge, often starting in one eye. A doctor can confirm if you are unsure.
What is the best eye drop for allergic conjunctivitis?
Dual-action drops containing ketotifen or olopatadine are usually the most effective over-the-counter choice. They relieve itching quickly and prevent further reactions when used regularly. Avoid using decongestant redness drops for more than a few days.
Is allergic conjunctivitis contagious?
No. Allergic conjunctivitis is an immune reaction, not an infection, so it cannot spread to other people. You do not need to stay home from work or school.
How long does allergic conjunctivitis last?
It lasts as long as you are exposed to the allergen. Seasonal symptoms can last for weeks during pollen season, while pet or dust allergy can cause year-round symptoms. Treatment and avoiding triggers usually control symptoms within a day or two.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Ophthalmology: Conjunctivitis Preferred Practice Pattern; Eye allergy diagnosis and treatment
- American College of Allergy, Asthma and Immunology: Eye allergy
- MedlinePlus: Allergic conjunctivitis
- NHS: Conjunctivitis
- Asthma and Allergy Foundation of America: Eye allergies