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Allergic Eye Disease

Allergic eye disease, or ocular allergy, most commonly manifests as allergic conjunctivitis. The conjunctiva is the transparent lining which covers the white of the eye and the undersurface of the eyelids. Conjunctivitis means inflammation of the conjunctiva. Inflammation of the conjunctiva due to allergy is allergic conjunctivitis.

Inflammation of the conjunctiva can be due to other causes, for example bacteria causing bacterial conjunctivitis. Bacterial conjunctivitis is contagious, whilst allergic conjunctivitis is not.

There are 5 main types of ocular allergy:

sneezing-eye-allergy

  1. Seasonal allergic conjunctivitis (SAC)
    allergic conjunctivitis which only occurs in spring and summertime, during the hayfever season.

 

  1. Perennial allergic conjunctivitis (PAC)
    allergic conjunctivitis which occurs all year round, and is most commonly due to dust mite allergy or pet dander allergy.

 

  1. Vernal keratoconjunctivitis (VKC)
    potentially sight-threatening allergic keratoconjunctivitis which occurs in children aged 5-15 years old, and is worst during spring and summertime.

 

  1. Atopic keratoconjunctivitis (AKC)
    potentially sight-threatening allergic keratoconjunctivitis which occurs in adults with skin eczema or those who had vernal keratoconjunctivitis in childhood.

 

  1. Giant papillary conjunctivitis (GPC)
    allergic conjunctivitis under the upper eyelid which is due to a foreign body in the eye such as a contact lens or protruding suture.

What are the symptoms of allergic eye disease?

  • Itchy eyeballs with a tendency to rub the eyes
  • Watery red gritty eyes
  • Stringy mucous discharge
  • Sensitivity to light
  • Eyelid swelling/ puffiness

 

Many people with allergic eye disease also have dry eyes and blepharitis. Contacting us for an expert evaluation by Miss Saw is the best way to determine what exactly is causing your symptoms.

 

The following information is provided as a guide only. Careful assessment and treatment by an eye specialist (ophthalmologist) or eye health professional who has the expert training and experience to accurately determine your diagnosis and best treatment approach is important.

 

Can I find out what is causing the allergy in my eyes?

Unless the allergy is due to an easily removable cause like a glaucoma eye drop, or wearing a contact lens or a protruding suture, it can be difficult to identify exactly which allergen(s) are causing the problem in allergic eye disease.

Identifying definite lifestyle changes which occurred immediately before the onset of the ocular allergy can help, for example moving home to a carpeted floor instead of wooden floorboards, suggests house dust mite allergy.

Previous studies indicate that skin prick testing results do not accurately correlate in allergic conjunctivitis, so it is not currently recommended.

However if a patient wishes nevertheless to identify which agents or eye make up they may be allergic to, referral to a consultant expert in skin prick testing is possible.

How is allergic eye disease treated?

First, avoid the allergen where possible.

Use a vacuum with a HEPA filter to reduce dust in your home, try keeping pets out of the bedroom to reduce dander exposure.

If pollen and seasonal allergens are the cause, sunglasses and a wide brim hat can reduce the amount of allergen that lands in the eyes, and saline eye drops to wash away the allergens can help.

If you use contact lenses, in general, do not wear lenses until symptoms have gone, however you may be advised by your eye specialist if you can wear contact lenses with certain types of eye drops.

Try not to rub your eyes, as this causes more inflammation. Use an artificial tear drop to wash away the itchy feeling whenever possible, rather than rubbing the eyes.

Try not to “fish” out mucus from the eyes, as this causes more mucus to be produced. Use an artificial tear drop to cleanse the mucus away.

Cool compresses with a towel or flannel soaked in cold water can help.

For short-term (for 2 or 3 months) relief of itchy red eye symptoms:

  • over-the-counter anti-histamine tablets (e.g. cetirizine, loratadine) and
  • over-the-counter mast cell stabilizer eye drops containing sodium cromoglycate 2%, 1 drop 2-4x/day, can help.

 

Long term intake of oral anti-histamine tablets (for more than 2 months continuously) can lead to dry eye due to reduced watery (aqueous) tear production.

Sodium cromoglycate eye drops are available preservative-free and these can be used with contact lenses in place. Preserved sodium cromoglycate eye drops in a bottle can be used morning and night in contact lens wearers, before inserting and after removing contact lenses each day.

Over the counter anti-histamine eye drops often contain a vasoconstrictor which makes the eyes white (e.g. antazoline antihistamine + xylometazoline vasoconstrictor). There is no problem using these for 1 or 2 days, for example for photographs for a special occasion. However it is not recommended to use eye drops containing vasoconstrictor continuously for more than 1 week, because rebound redness of the eyes will occur when the vasoconstrictor is stopped. 

Combined Drops

Combined mast cell stabilizer- antihistamine eye drops such as Olopatadine or Ketotifen are very effective for itch and redness due to allergy. They can be used safely all year round if necessary. These must be prescribed by a doctor.

Olopatadine can be used morning and night in contact lens wearers if prescribed by your eye specialist, before inserting and after removing contact lenses each day.

Other mast – cell stabilizing eye drops which may be prescribed by your eye specialist include nedocromil and lodoxamide.

Corticosteroid eye drops

may be required for more severe inflammation and mucus discharge. Steroid eye drops are most commonly used 1-4x/day. Steroid eye drops are associated with development of glaucoma (high intra-ocular pressure), cataracts and infection, so only using the minimum amount of corticosteroid necessary to treat the redness and improve comfort is the goal.

Ciclosporin eye drops

For chronic inflammation due to allergic eye disease, Ciclosporin eye drops may be indicated. They reduce inflammation safely, without causing the side effects associated with steroid eye drops. They have a slow onset of action and the eye drops sting during approximately the first month of use.

Steroid Creams

For puffy redness of the eyelid skin, steroid creams may be prescribed by Miss Saw. These must be used sparingly and for limited periods, because they can make the skin of the eyelids thin and can cause high intraocular pressure. Inflammation frequently returns when steroid cream is stopped.

If the eyelid skin has chronic recurrent eczema, topical anti-inflammatory cream such as pimecrolimus or tacrolimus 0.03% or 0.1%, which does not have the side effects of steroids, may be prescribed.

Oral corticosteroids or local corticosteroid injection

Oral corticosteroids or local corticosteroid injection in the eyelids may be required in some severe cases of allergic eye disease. Corticosteroids are only used for limited periods of time to rapidly control inflammation.  This is in order to minimise the side effects of long term corticosteroids (Cushing’s syndrome, infection, bone thinning, thin skin with easy bruising).

Systemic immunosuppression

For patients with severe eye inflammation and severe skin eczema, systemic immunosuppression with ciclosporin, tacrolimus or mycophenolate may be indicated. This must only be commenced by a specialist who is expert in systemic immunosuppression, and in collaboration with the patient’s dermatologist. 

Immunotherapy (allergy shots)

Immunotherapy (allergy shots) can help in some people. It is mainly available for hay fever sufferers, to provide long-term resistance to triggering allergens.

What is the long term disease course in Allergic Eye Disease?

Perennial and Seasonal allergic conjunctivitis are not sight-threatening conditions. Like hayfever, they may be present for the rest of one’s life.

Most children grow out of vernal keratoconjunctivitis once they are in their 20s. The vernal children who continue to have active chronic allergic eye disease after the age of 20 are then called atopic keratoconjunctivitis.

 

Can I go blind?

Perennial and seasonal allergic conjunctivitis themselves are not sight-threatening conditions. Vernal and atopic keratoconjunctivitis are potentially sight-threatening and often require treatment with topical and/or oral steroids and immunosuppressive therapy. Both vernal and atopic keratoconjunctivitis can cause permanent scarring of the cornea, the clear front window of the eye, and damage to limbal stem cells.

Keratoconus is often associated with allergic eye disease (SAC, PAC, VKC, AKC). Avoiding eye-rubbing is thought to be important, to prevent the development or worsening of keratoconus. See “Keratoconus”.

Atopic keratoconjunctivitis is also associated with reduced immunity against Herpes simplex infection and Staph infection. Herpes simplex affecting the cornea can lead to permanent scarring of the cornea and blindness.

 

Useful links:

Allergy UK http://www.allergyuk.org

 

Valerie Saw is an experienced expert in managing allergic eye disease.

 

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  • As I got older my eyes deteriorated! I had glasses throughout the house, and it irritated me. It even influenced my sports. This operation has given me perfect vision, I could not be happier! Thank you Ms Valerie Saw and the team for the perfect treatment. Highly recommended.

    Yvette Van Leeuwen

  • After years of suffering with dry eyes and several visits to consultants in the Midlands, I was getting extremely frustrated and losing hope of finding anyone who could understand my problem fully and offer me sound advice with a plan for improvement. I had both Meibomian gland dysfunction and aqueous tear deficiency, with occasional secondary inflammation. Since 2002 I had used a variety of drops and also tried punctal plugs, but had developed infections.

    After another search on the Internet and looking at London consultants, I noticed Ms Saw had an amazing CV and had Dry Eye as one of her areas of expertise. My first visit to Valerie in March 2015, instantly gave me the hope I was seeking. She was so understanding, reassuring and kind. Valerie took time to investigate and diagnose my symptoms fully and I came away with a new treatment regime offering various options, as part of a plan for improving my condition in the short and long term. As one of my treatment options, Valerie carried out Cautery of the lower tear ducts and fitting of a punctual plug in one of the upper.

    In 2016 my eyes are now far more comfortable and I am slowly reducing medication. I am using a good combination of drops and ointment and continue with a hot massage routine.
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    Alexander Collis

  • Ms Valerie Saw is a friendly and very professional eye surgeon. She is very thorough during the examination. Valerie immediately put me at ease providing just the right amount of information to enable me to make the right decision about having laser eye surgery (after over 45 years of wearing glasses for astigmatism and myopia the idea was a bit scary!) During the surgery when I was quite nervous Valerie was reassuring, efficient and kept me fully informed. After surgery I received complete care and attention. Valerie made sure I understood exactly what I needed to do to take the best care of my eyes. I now have great vision with no glasses at all, even reading a computer screen all day.

    Chris Stott

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    Verity Westcott

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  • "Calm and clear. I was particularly grateful for being able to contact Valerie both pre and post-surgery with questions. The teams both in Valerie’s practice and at Moorfields were friendly, reassuring and approachable. Thank you for taking such good care of my sight!"

    O. Robinson

  • I had absolutely no idea of what to expect when I discovered cataracts in my eyes. And I was living abroad. On my first visit, during my initial consultation Valerie explained in very simple but concise terms what to expect and was able to put my mind at ease. She also fully outlined what type of resulting vision to expect including all the main side effects. I came back to London 3 months later and we were able to operate on both eyes, and I left London a week later, fully armed with instructions and eye drops. Due to being abroad I called once just to discuss over the phone how I felt my vision was and to ensure that I was on track. Once again even from afar Valerie was spot on with advice and suggestions. Six months on and I have had my follow up visit. My eye-sight is perfect, the side effects are minimal. I would highly recommend Valerie Saw to anyone considering eye surgery; you can be certain of being in good, professional hands with optimum results.

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    David Pollicott

  • I was considering having laser eye surgery on my right eye. I consulted Valerie who diagnosed me with keratoconus. Valerie recommended inserting a Keraring in my eye instead of laser treatment. The results are amazing, 20/20 vision achieved. I cannot thank Valerie enough.

    Kevin Carnegie

  • I was so afraid of this operation but Ms Saw has a calm and gentle manner which is so reassuring to the patient. Her skills are outstanding – I can’t remember being able to see from early childhood, but because of Ms Saw’s abilities a miracle has occurred and I can see when I open my eyes. I am so grateful to her.

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    Leonardo L.

  • What a lovely lady! What a fantastic surgeon. My husband has only had one good eye since birth, and that was getting worse and worse. He had to wear glasses all the time and it makes things like wearing goggles for skiing and workshop tasks difficult. He went to a couple of laser surgeons to find out if he could have something done to this one eye, but, they wouldn't even consider it in case something went wrong. However, we went to see Miss Saw and she didn't see any problems, she only saw solutions. He now has 20/20 vision in that eye and sees better than he has since his 20's. It was easy, friendly and a comfortable experience for both of us. Can't praise her enough. Wonderful, she has changed his life.

    Carole Jones

  • Having laser eye surgery was the best decision I have ever made and, given the serious nature of the surgery, I researched the procedure and the best surgeon for me before committing to it. The whole experience was excellent - professional, caring and I was kept completely informed throughout the process.

    Katie Price

  • Absolutely delighted with result and service, couldn't be happier!

    Heather Pearce

  • I went to a number of eye clinics who all failed to spot my cataracts. Valerie was quick to diagnose and treat my various needs and swiftly achieved great results. If you are worried or in need of advice or quality care I would recommend Valerie.

    Nicholas Pollitt

  • Ms Saw and her team are very friendly and professional – they made sure I understood everything beforehand and explained exactly how the procedure would go so I knew what to expect. Ms Saw’s manner is calm and reassuring and I am thrilled with the results.

    Kit Roberts

  • Valerie was highly professional and very competent indeed and the Lasik surgery on my left eye went really well. The procedure was explained very clearly in advance and the procedure itself was quick and painless and has resulted in clear long distance vision in the eye. It all went very well and I can strongly recommend Valerie.

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    Andrew Lee

  • While I was initially quite frightened and apprehensive considering eye surgery to correct my short sightedness, I opted to go to Valerie Saw at Moorfields due to the consistency of references I had received about her. This was absolutely the right decision. She worked carefully with me, addressing all my concerns and answering my questions, no matter how unusual! In the end we planned a surgery type that was right for me, and I felt confident on the day that I was being looked after as well as I had ever hoped. Valerie comforted me massively during the surgery, and offered me all sorts of advice and post surgery care as I recovered. I highly recommend her to anyone, and I am very grateful.

    Matt De Moraes

  • From start to finish I felt supported, informed, safe and unpressured. Any concerns were dealt with immediately and I was re-assured at all times. Follow up post op is excellent and more than I had ever expected. Ms Valerie Saw was amazing, so calm, knowledgeable and professional. Moorfields exceeded my expectations and I recommend them to all considering laser surgery. It’s worth spending the extra to know you will have the best.

    Carla Finlayson

  • I had lens replacement (IOL, RLE) surgery to fix short-sightedness in Feb/Mar 2013. I’ve had my first annual check up everything is fine. I’m extremely happy with the outcome and would happily recommend this surgery to anyone, especially if you have severe short-sightedness. Valerie Saw is not only highly qualified, but helpful, kind, gentle and patient as well and I highly recommend her to anyone considering this type of surgery.

    Louise De Kock

  • Having a very high prescription most of my life was restricting in everyday life. I waited until I was ready to take the plunge and have the eye surgery (mainly due to confidence and checking to see what would be suitable for my high prescription). Ms Saw has been very helpful and supportive during the whole procedure and we have both been surprised and happy by the results of the surgery

    Deepkamal Bakhshi

  • I have always considered having laser eye surgery. After using contact lenses and glasses for over 10 years, I decided to go ahead with it. After going online to look at reviews on Moorfields website Ms V Saw had very good feedback. Having had a consultation which was brilliant and answered all my questions, I then decided to proceed with surgery. Obviously going in for the surgery can seem quite daunting but everyone, especially Miss Saw, put me at ease and told me what was happening throughout the procedure. It has been the best thing I have ever done and would do it all over again! Miss Saw was fantastic. I would recommend her to anyone considering Lasik Surgery. Thank you!

    Elizabeth Godfrey

  • Lens replacement surgery in November 2016.
    Not needing reading glasses is amazing!

    Rick B.

  • Great level of care. I felt that they really cared at all stages through the consultancy all the way to the surgery and then the aftercare. I was able to call anytime if I had a problem. Perfect vision. I would highly recommend it to anyone considering laser eye surgery.

    Taharul Islam

  • I had LASIK after suffering from iritis and blepharitis. I was very nervous about the procedure but Ms Saw was very clear in explaining what would happen, which made me feel at ease on the day. My LASIK result was overwhelming with joy that such instant results could change my sight from -6.5 to 20/20. Thank you!

    Elizabeth Selvey

  • Ms Saw is an outstanding surgeon. Very clear information and individual attention as I had long standing conjunctivitis and blepharitis as well as myopia. Felt fully prepared for the surgery and extremely confident in her skill. Delighted to wholeheartedly recommend both the procedure and Ms Saw. Can’t believe I didn’t have this done years ago!

    Emma Hawkes

  • Ms Valerie Saw’s team were very attentive and helpful. I had LASEK surgery which has longer recovery time and is more painful. Ms Saw ensured the pain has kept to a minimum and even came in on a Saturday to check how my eyes were healing! All my questions were answered promptly.

    Jabin Ahmed

  • By the end of the first consultation, I felt sure I knew what I was entering into. During the surgery, Ms Saw explained the progress the laser was making, and kept me calm. I would highly recommend having the surgery with Valerie Saw, who is calm in speech and professional in approach, essential qualities when dealing with patients looking to make important decisions on issues as sensitive as their sight.

    Aatish Thakerar

  • Had my surgery over a year ago. Currently still no issues and have better than 6/6 or 20/20 vision. Miss Saw was very thorough and that gave me the confidence to go ahead with the surgery. She also explained that if I had any issues after surgery to contact her immediately. That alone gave me confidence I was in good hands. The surgery was quicker than I expected. Before long I suddenly could see with a lot of detail. Also to note Miss Saw is very gentle as well. Best thing I have ever done and better still with such an excellent surgeon.

    Sarah Datson

  • I am extremely glad I went with Valerie and her team, they were friendly, caring, informative and professional. The surgery was so quick, easy and pain free. I was extremely nervous about the procedure, just the thought made my stomach turn. Valerie and her team made me feel extremely relaxed and explained the procedure clearly to me. The nurses on the day were really helpful and explained all the aftercare drops to me. I still can’t believe I went through with it but so glad I did and would recommend it to anyone and would highly recommend going to Moorfields and having Valerie as your surgeon. Her voice is extremely calming whilst the procedure is taking place.

    Sarah Dean

  • The initial examination was thorough beyond all previous experience and her advice complete, informative and very reassuring. Taking the plunge I elected to have lasik surgery and the procedure was duly completed without pain in a calm and comforting environment by a scrupulously professional team led by Valerie. Despite the recent surgery there was an immediate and staggering improvement in my vision and within 12 hours I could read newsprint without the aid spectacles. It is now 4 months since the procedure and having undergone 3 equally thorough post operative checks the result continues to improve. I am now free to pursue my passion for wildlife photography and bird watching without the constant annoyance of spectacles hanging around my neck and the only regret is that I didn't have the procedure carried out years ago! If you are in any doubt forget it, make an appointment to see Valerie, put your trust in her abilities and enjoy a life changing experience. Brilliant!

    Nick Stantiford

  • I highly recommend undertaking laser surgery with Valerie. I had a very high prescription (-8) and was wearing spectacles and then contact lenses since I was 5 years old. I was a bit apprehensive at the start but Valerie was very reassuring from the beginning. I received all the information I wanted allowing me to make my choice. The surgery (in May 2016) didn’t take long at all and the discomfort only lasted a couple of hours. I was provided with a range of drops including anesthetics drops against the pain which were very efficient. After a few hours, I was seeing and my vision settled very quickly after then. I was driving my son to school after 48h. Valerie gave me her mobile number allowing me to call her, anytime (even during the weekend) if I had any concerns. This was really reassuring. She is making herself available for her patients and is very caring. My vision is now perfect, which is an amazing and crazy feeling! Whenever friends mention laser surgery, I encourage them to see Valerie as I know they will be in very safe hands. The clinic facilities at AVC are very clean and modern, as you would expect for private facilities. You are very well looked after all way through.

    Lauren A.

  • Dr Saw completed my laser eye surgery in November 2016. Her team completed a thorough pre-assessment of my eyes and determined I was suitable for surgery. On the day of the surgery I was walked through the process step-by-step to ensure I was comfortable with what was going to happen, as well as information about how long different things would take.
    I’ve had several follow up appointments and have reached out to Dr Saw multiple times with questions, all of which have been responded to promptly. My vision is now better than 20/20.
    
My wife is also looking to get laser eye surgery and we'll definitely be going back to see Dr Saw!

    Graham R.

  • Extremely pleased with the results from my laser eye surgery with Ms Saw. Perfect vision, better than 20:20. Still marvelling at the view 4 months on. Ms Saw and her team are kind, thorough, professional and provide excellent care and advice. Highly recommend.

    Justin Wilson

  • Having worn glasses since the age of 8, it was difficult to explain the decision to undergo surgery to correct my vision. However, how glad I am that I went through with it. Valerie was amazing, patiently explaining everything and answering questions, even in the run-up to the surgery date. On the day itself, Valerie and her team made the whole experience calm and stress free and it is astounding that such a life changing result can be achieved so easily, and pain/ stress free. I had the surgery in February and have recently returned from an early summer holiday – no glasses, prescription sunglasses, contact lenses, comfort drops etc. Just my new eyes and a pair of sunglasses! I would thoroughly recommend the amazing Valerie and Moorfields hospital.

    Tony Millward

  • Very satisfied with my treatment. Ms Saw is excellent and the quality of aftercare is fantastic. I would highly recommend treatment here and I am delighted with the results.

    David Sindall
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