Itchy and red eyes are symptoms experienced by millions of people on a daily basis.  There are many causes of these symptoms so when an over-the-counter treatment fails it leads people to seek help from their eye doctor to provide fast relief and prevent other eye complications. I’d like to take a moment to discuss some of the major causes and what can be done to help, but you will notice there are a variety of treatments that are guided by a careful diagnosis of the specific cause of the itch.

Let me start by saying that often red, itchy and watery eyes can be caused by multiple conditions affecting the eyes at the same time. Also, depending on the condition, many treatments may only reduce the symptoms but not the underlying cause. This is where the experience of your optometrist will be most helpful.

One of the most common culprits of itchy eyes is allergy.  When you allergies affect your eyes it is called allergic conjunctivitis.  You’ve probably heard of conjunctivitis (a.k.a. “pink eye”) and allergic is just one of many variants.  Like all allergies, eye allergies are caused by a glitch in the body’s immune system trying to fight off the threat of harmless allergens by releasing histamine.  This causes the eyes to get red, watery and itchy.  Your vision may get a bit blurred and the eyelids often get puffy.

Of course, allergies may affect other areas so you can experience nasal allergies at the same time. And just like nasal allergies you may be affected in the spring and fall (seasonal allergies) or all year round (perennial). Treatment for ocular allergies will range from simple (or maybe not so simple) action such as staying away from the substance (allergen) that causes the reaction.  Mild symptoms may be relieved by using artificial tears to wash away allergens or an over the counter medication like Zaditor especially for mild itching without any redness. However, when symptoms are moderate to severe and especially when the eyes are itchy AND red, medical intervention (prescription Pataday or Lastacaft) is usually indicated.

Other forms of “pink eye” such as viral conjunctivitis can cause itching though usually the main symptom is redness and discharge.  One interesting note is that viral cases are commonly contagious.  This means a the patient who is dying to rub the itchy eye is much more likely to spread the infection to the other eye (and possibly to other people).

Another cause of itchy eyes is dry eyes which again has multiple variations.  Often dry eyes and allergies exist at the same time with the dryness intensifying the allergy symptoms.  One form of dry eyes causes the eye to produce a low quantity of good quality tears.  Over the counter lubrication may temporarily wet the eye, but a prescription of Restasis often helps your eye actually produce more tears. On the other hand, inflammation of the glands within the eyelids can cause ample production or poor quality tears.  People with this condition will often notice their eyes are dry and itchy even though they water.  Often they will notice the symptoms are worse earlier in the morning.  The key to reducing their itchy and dry eye symptoms is to control the inflammation thus providing better quality tears.

Finally its always wise to consider contact lens wear as a possible cause of itchy eyes. Either the contact lens material itself or the cleaning and storing solutions can be the cause, especially if one has been changed recently.  Other times protein and deposits on the surface of the lens will build up more so the longer the lens is worn causing bumps under the eyelids called Giant Papillary Conjunctivitis (GPC). When your optometrist flips your upper eyelid over during your contact lens exam he or she is mainly looking for GPC.

Temporarily reducing contact lens wear as well as disposing the contact lenses on a more frequent schedule will often eliminate the itch, but sometimes a prescription anti-inflammatory eye drop such as Lotemax will be used to both help with symptoms as well as reduce the GPC. Contact lens wearers with allergies or GCP do very well with daily disposable contacts.

The symptoms of red and itchy eyes can have many causes.  Though allergy is probably the most common cause of pure itching, you want to consider other etiologies especially if simple antihistamine eyedrops are not making a big improvement in symptoms.  If that is the case, see your optometrist to get an accurate diagnosis and quick relief for your red and itchy eyes.

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