With the middle of August comes the final few weeks of the summer season, a look ahead to Labor Day, the start of another school year and a busier time in general for most of us. But mid-August can also mean something else for allergy sufferers: an early start to the “fall allergy” season—a time when eye allergies can negatively impact the last few weeks of summer fun.

“When fall allergies start really depends upon the location, climate and individual reactions to pollen levels and types,” said Susan A. Primo, OD, MPH, FAAO, director of Optometry and Vision Rehabilitation Services, program coordinator, Optometric Residency, Emory Eye Center and professor of ophthalmology at Emory University School of Medicine in Atlanta. “It can vary whether you are in Georgia, California or New York. Some regions or states have year-long seasons. The most common ophthalmic symptoms are watery, runny and itchy eyes. People can also get runny or stuffed up noses, sneezing, sore throat and cough.

“Some people are just more prone to allergic reactions, but anyone can develop a hypersensitivity reaction even later in life, especially after living in a climate for a few years. The key is finding out what the trigger is and addressing it earlier rather than later,” Dr. Primo advised.

According to the American Academy of Ophthalmology, eye allergies, also called allergic conjunctivitis, are quite common. They occur when the eyes react to allergens. The eyes produce a substance called histamine to fight off the allergen. As a result, the eyelids and conjunctiva become red, swollen and itchy. The eyes can tear and burn. Unlike other kinds of conjunctivitis, eye allergies do not spread from person to person. The most common eye allergy symptoms include red, swollen, or itchy eyes, burning or tearing of the eyes and sensitivity to light.

 
 Susan A. Primo, OD, MPH, FAAO.
“Try to avoid the allergen as much as possible by staying inside during high pollen counts or wearing a mask if you must go outside,” Dr. Primo recommends. “Start an oral antihistamine sooner rather than later. Then you can reduce the body's overall response a bit better and control the ocular effects like watery, runny and itchy eyes. Some people really have a strong reaction in their eyes and may need prescription eye drops and maybe even steroids.

“Getting a head start in lowering histamine levels in the body can go a long way. If patients have a predictable pattern, they should start oral antihistamines a week or two before so they don't end up with out-of-control symptoms. Unfortunately, these oral agents must be taken daily to keep levels down and in control. Taking [meds] sporadically usually causes flare ups,” she advised.

Eye allergies also do not discriminate. Adults and children can both develop symptoms, while special care should also be taken for contact lens wearers. With back-to-school season underway across the U.S., making sure children’s eye allergies are treated is extremely important.

“Give school-aged children who must be outside oral antihistamines at night so it can help them the following day with symptoms,” said Dr. Primo. “Getting kids allergy tested is also good to determine what the exact triggers are and to try to avoid those triggers. Kids also can wear masks when outdoors if the allergens are in the area or ask to remain indoors during peak season.

“Having allergic eye symptoms or conjunctivitis usually gets worse for contact lens wearers to the point that some people can't even wear the lenses at all. Keeping the eyes heavily lubricated with artificial or natural tears can help alleviate some of the symptoms and flush the allergens or pollen out,” Dr. Primo said.

Dr. Primo tries to stay ahead of allergy season, often starting an oral histamine sooner rather than later in many of her patients.

“I try to start with getting patients to try to predict a pattern as to when their allergic reactions usually begin and then starting an oral histamine a week or two before that. It's harder to control once the histamine levels are really high in the body and in the eye,” Dr. Primo said. “I typically recommend my ‘allergy protocol’ which starts with an oral antihistamine. Some work better than others, so patients need to find the one that works best for them. Sometimes people have to alternate or change their oral medication to be most effective.

“My protocol also includes a saline or ocean nasal spray, cold compresses for itching (no eye rubbing) and artificial or natural tear drops several times per day. If ophthalmic symptoms really become uncomfortable or out of control, there are OTC as well as prescription eye drops that can help control the symptoms. Make sure to contact or see an eyecare provider to determine which might be best or most effective, as there is a big range. Again, many of the ophthalmic symptoms can be best controlled with oral antihistamines, cold compresses and natural or artificial tears,” Dr. Primo said.

And of course, ODs and eyecare providers can play a critical role in helping patients cope with eye allergies.

“As a patient's primary eyecare provider, we (ODs) can really help work in concert with an allergist or primary medical care provider to help minimize the effects of allergic symptoms in the eye,” said Dr. Primo. “We can also implement our predicted preventative care by bringing awareness to start oral medications before the season officially starts.”

Prevent Blindness offers guidance for the proper way to put eye drops in your eyes. Prescription eye drops are one of the ways to help ease the itching and redness often associated with fall allergies.