Watering and Burning and Itching, Oh My!

By Patricia M. Fulmer, OD, FAAO
Legacy Vision Center

Spring has sprung, and while it’s easy to love the beauty of the season, the pollen that accompanies it is unwelcome. At Legacy Vision Center, this time of year brings complaints of itching, burning, watering and/or red eyes with the assumption that the culprit is allergies.

Many times, that’s not wrong…however, did you know that dry eye disease (DED) can cause similar symptoms? Or that sometimes the two work together to make you uncomfortable? How can you know which problem you might be suffering from so you know how to make things better?

To discern between which condition might be causing your symptoms, it is important to understand the basic anatomy of the front of the eye. The ocular surface is comprised of the lids and lashes, the tear film, the conjunctiva (a clear tissue that primarily covers the white part of the eye), and the cornea. These structures must work properly and in unison for our eyes to remain healthy, comfortable, and clear.

So which structure is involved in each condition?

In dry eye disease, clinical changes occur within most or all of the ocular surface structures. The eyelids, which house our meibomian glands, are the most common starting place for DED due to increasing digital device use. These glands are responsible for producing the oil that is the outer layer of your tear film, and when we participate in activities that require staring (such as computer work), our blink rate decreases and the oil thickens. This leads to a thinner tear layer which evaporates off the eye significantly faster. Advancing DED will show signs of irritation on the conjunctiva and cornea.

In ocular allergy cases, the main clinical signs will present in the conjunctiva and will be noted as small bumps under the eyelid. Varying levels of conjunctival swelling can be commonly seen, particularly in the nasal corner.

Are the symptoms the same?

The most common symptoms of DED include redness, burning, foreign body or gritty sensation, watering, and discomfort. Other symptoms may include transient blurred vision and itching, the latter being the reason people mistake DED for allergies.

Patients with ocular allergies overwhelmingly report itching. Watering and transient blur are also common, though less marked than the “itch” complaint. Redness and discomfort may also be present.

What causes these problems?

DED is an inflammatory condition with numerous different causes. Digital device use, age, gender, underlying systemic problems (particularly autoimmune disorders), and medications are the most common culprits. Environmental factors such as air quality, humidity levels, and exposure to chemicals or particles can also contribute.

Ocular allergy is almost exclusively environmental. Pollen is the most common trigger, but pet dander, mold, and even underlying food allergies can prompt symptoms.

How do I treat my eyes?

Many times, therapy requires over-the-counter eye drops. However, selecting the wrong drop yourself can lead to worsening symptoms. For example, incorrectly using antihistamine allergy drops will worsen DED. Therefore, it is important to obtain a proper diagnosis and treatment plan from your eye doctor.

Other potential steps include nutritional supplements, heat therapy, prescription drops or targeted lid treatments. At Legacy Vision Center, we are proud to utilize all of these including radiofrequency and intense pulse light therapy as indicated. Give us a call to see how we can help you enjoy your Spring!

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