Itchy eyes, also known as ocular pruritus, are the most common problem encountered by ophthalmologists among their patients. It is defined as the unusually increased sensation of itching around the eyes. Although ignored as a minor problem, it often increases the patient's distress, thus deteriorating their quality of life.

What Are the Factors Responsible for Causing Itchy Eyes?

Several reasons cause patients to present with itchy eyes. The factors responsible for ocular pruritus are broadly grouped into the following groups.

Ocular pruritus is caused due to skin conditions.
Ocular pruritus is caused as a side effect of ophthalmic medications.
Underlying ocular conditions cause itchy eyes.

The allergy of the eye is the most prominent cause of itching of the eyes. Other causes include:

Dry eye syndrome.
Meibomian gland dysfunction.
Blepharitis.
Loose contact lenses.
Giant papillary conjunctivitis.
Contact lens-induced conjunctivitis.
Vernal keratoconjunctivitis.
Atopic dermatitis.
Chemicals.
Infection.
Foreign bodies.

Drugs like:

What Is the Mechanism Behind the Initiation of Itchiness of the Eyes?

The main reason behind the itching of the eyes depends on the body's immune reaction towards the outside or foreign body.

The immunologic reactions encountered in the case of allergic conjunctivitis and blepharitis are immune-mediated conditions.
Contact lens-induced conjunctivitis has a multifactorial cause, including trauma, inflammation, and protein deposits.
Dry eyes seen in Sjogren's syndrome are mainly associated with an autoimmune pathology.
Meibomian gland dysfunction (MGD) causes stimulation of the inflammatory mediators, resulting in hyposecretion of tears which clinically presents as dry eyes and itching.

What Are the Symptoms Reported by Patients Suffering From Itchy Eyes?

The symptoms reported by patients with ocular pruritus depend on the underlying state:

Allergic conjunctivitis often presents with long-term itchiness of the eye.
Dry eye syndrome and MBD patients often experience foreign body sensations with tearing or burning of the eyes.
Conditions like atopic dermatitis and allergic conjunctivitis also report the presence of other conditions such as asthma, allergic rhinitis, and eczema.
Often ill-fitting and soft lens wearers report itching of the eyes.
Patients with itchy eyes also report exposure to triggering factors like pollen, pets, warmer climate, etc.
Contact dermatitis blepharitis is often linked to a recent change in using new creams, makeup, and soaps.

What Are the Clinical Signs to Look Out for in Patients of Ocular Pruritus?

The ophthalmologist's comprehensive examination of the different eye parts is essential to detect the underlying cause and form an appropriate treatment plan for the itching.

Examination of the Eyelids:
- Eyelids are examined for swelling, scales, leathery feeling, hyperpigmentation surrounding the eyes (periorbital hyperpigmentation), and crusting of the eyelids.
- Swollen eyelids are seen in allergic conditions. Scaly and leathery eyelids are associated with atopic dermatitis.
- Periorbital hyperpigmentation (allergic shiners) are observed in allergic situations.
- Blepharitis shows crusting of the eyelids, while patients with MGD exhibit foamy tears and pinpoint rupture of the blood vessels in the eyelid.
Examination of the Conjunctiva:
- Conjunctival signs in patients with itchy eyes include mild to moderate redness and mucous discharge redness.
- Small bumps (papillae) are found in the upper and lower palpebral conjunctiva.
- There is the presence of allergic reactions in the palpebral part of the conjunctiva.
Examination of the Cornea:
- The cornea is evaluated for epithelial erosions, infiltrates, Horners-Trantas dots, and ulcers.
- Punctate epithelial erosions are common in all patients with itchy eyes. In addition, epithelial infiltrates are seen in MGD patients.
- Horner-Trantas dots and shield ulcers are the classical signs of vernal keratoconjunctivitis.

Which Is the Most Common Site for Itchy Eyes?

Itching may be present involving the whole eye. However, the most common site presenting with itchy eyes include:

Eyelids.
Eyelashes.
The base of the eyelashes.

What Clinical Presentations of Itchy Eyes Requires Immediate Attention of the Specialist?

The signs or symptoms that warrant a specialist’s attention are:

Thick discharge.
Persistent itching.
Inability to open eyes.
Blurred vision.
Sensitivity to lights.
Halo around lights.
Swollen eyes.
Painful eyes.
The difference in pupil sizes.

What Are the Various Approaches Used to Treat Patients With Itchy Eyes?

The management of the itchy eyes mainly aims to remove the underlying cause and eliminate the symptoms.

The antihistamine eye drops are prescribed for patients with itchy eyes caused by an allergy. Oral antihistamines are prescribed for severe cases.
Administration of steroid injections around the eyes
Lubricating agents or artificial tears are administered in patients suffering from ocular pruritus and dryness of the eye.
Patients with long-term corticosteroids are also prescribed antibiotic drops to prevent superinfection.

Is It Possible to Manage Itchy Eyes at Home?

There are several self-help measures that patients can adopt to manage itchy eyes initially. However, persistently itchy eyes require specialist attention.

Place a damp cloth or ice pack over the eyes.
Maintenance of good eye hygiene.
Regulate the room temperature and humidity.
Bath the eyes with cool water.
Avoid rubbing your eyes.
Dry eyes can be treated by rapid blinking of the eyes with the administration of artificial tears.

How Can Lens Wearers Manage Itchy Eyes?

Lens wearers can adopt the following measures to manage itchy eyes:

Regular changing of the lens.
Wash the lens daily.
Change the lens liquid daily.
Keep the solution case clean.

What Are the Various Measures Adopted to Prevent Itchy Eyes?

Itchy eyes that are caused by any allergen or previously known allergic body are prevented by avoiding exposure to triggering agents. The steps to be followed to avoid itchy eyes are:

Avoid smoking.
Avoid scented candle usage.
Use an eye patch to avoid exposure to an allergen.
Regular lubrication of the eye.
Consume vitamin A and Omega-3 fatty acids.

What Are the Other Risks Associated With Itchy Eyes?

Patients with ocular pruritus and under non-steroidal anti-inflammatory drugs (NSAIDs) can suffer from corneal melts or perforation. In addition, patients administered with corticosteroids are prone to superinfections. Hence patients with itchy eyes require long-term follow-up.

Conclusion

Itchy eyes are the most frequent problem of the eye associated with the body's immune reaction. However, it presents with an insignificant presentation clinically. Therefore, appropriate treatment of the condition is crucial for improving the patient's quality of life.