Itchy, red eyes: Infection or allergies?

With spring at its peak and tree pollen in the air, many children are suffering from itchy, watery, red, and swollen eyes. If your child is among them, it can sometimes be hard to tell whether it's allergic conjunctivitis or an infection.

With allergic conjunctivitis, the eyes will be very itchy, but should not feel painful, symptoms are present in both eyes, eye secretions are watery, the eyelids may be swollen, and there are often nasal symptoms, too. Children do not typically develop fever with allergies. When pollen is to blame, children will likely experience more discomfort when they are outside than indoors. Symptoms will be present throughout the pollen season, which can last months.

On the other hand, infectious conjunctivitis, caused by bacteria or viruses, will usually start in one eye, but may eventually involve both eyes. The eyes feel more irritated or burning rather than itchy, and there is usually thick mucous or pus present, especially in the morning. The infection may be accompanied by fever and other viral symptoms. If your child has these complaints, a primary care clinician can help with diagnosis and treatment.  Bacterial conjunctivitis is typically treated with prescription antibiotic eye drops or ointments, with symptoms improving after a few days of therapy. It can take two to three weeks for viral conjunctivitis to resolve, and it will get better without medication.

Both allergic and infectious conjunctivitis can lead to crusting of the eyes in the morning, affect both eyes, and cause discomfort. Your child's doctor can help discern the cause if you are unsure, as sometimes the diagnosis is not clear. If your child complains of eye pain, light sensitivity, vision change, or has a headache or vomiting with eye complaints, it is important to seek urgent medical care. These symptoms can signal a more serious problem.

In this part of the country, the most severe seasonal allergic conjunctivitis symptoms are related to tree pollen and the worst months for this allergen are usually April and May, though tree pollen season spans February through June. Children with allergic symptoms should see an allergist so that testing can be completed to confirm the cause and help guide therapy. Treatment options include allergy eye drops, oral allergy medications, nasal sprays, and allergy shots. Over-the-counter drops that are marketed to relieve redness are not the preferred treatment for allergies.

For kids with severe pollen allergy, the best preventive measure is to decrease any unnecessary allergen exposure. During the height of allergy season, parents will want to keep windows closed in the house and car, use air conditioning instead of window fans, and avoid hanging clothes outside to dry. Children should promptly bathe and change clothes after playing outdoors.

Finally, we do not want allergies to slow a child down or be disruptive to quality of life. With testing and proper treatment, even children with severe seasonal allergies can enjoy beautiful spring days. If bothersome symptoms are preventing your child from spending time outdoors, or disturbing sleep, school, or social activities, an allergy specialist will be able help your child find relief.

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