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Itchy Eyes - Causes, Clinical Presentations, and Management

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Itchy eyes are the most common symptom experienced by patients with eye diseases.

Written by

Dr. A. Srividya

Medically reviewed by

Dr. Gargi Madhukar Apte

Published At August 19, 2022
Reviewed AtJanuary 5, 2024

Introduction

Itchy eyes, or ocular pruritus, are the most common problem ophthalmologists encounter among their patients. It is defined as an 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 Causes of Itchy Eyes?

Several reasons cause patients to present with itchy eyes.

The factors responsible for ocular pruritus are broadly grouped into the following groups.

  • Skin conditions cause ocular pruritus.

  • The side effects of ophthalmic medications cause ocular pruritus.

  • Underlying ocular conditions cause itchy eyes.

  • Eye allergy 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.

  • Stress and fatigue.

  • Seasonal changes.

  • Drugs like:

  • Medical conditions like:

    • Hay fever.

    • Eczema.

  • Autoimmune disorders.

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 toward 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 the hyposecretion of tears, which clinically presents as dry eyes and itching.

How to Maintain Contact Lens Hygiene?

Contact lenses should be changed regularly, as bacteria can colonize the surface of soft contact lenses. To prevent any infection from the lens

  • The eyes should be lubricated regularly with artificial tears.

  • The contact lens should be rubbed and cleaned properly.

  • The contact lens case should be washed, and the liquid where the lens should be placed should be changed daily.

  • If the irritation caused by contact lenses does not subside, then consult a doctor for an alternative.

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, such as tearing or burning the eyes.

  • Conditions like atopic dermatitis and allergic conjunctivitis also report 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 climates, etc.

  • Contact dermatitis, or blepharitis, is often linked to a recent change in using new creams, makeup, and soaps.

Itching may be present involving the whole eye.

However, the most common sites presenting with itchy eyes include:

  • Eyelids.

  • Eyelashes.

  • The base of the eyelashes.

What Is Ocular Pruritus Diagnosed?

The ophthalmologist's comprehensive examination of the different eye parts is essential to detecting the underlying cause and forming 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 around the eyes and mucous discharge redness.

  • Small bumps (papillae) are found in the upper and lower palpebral conjunctiva.

  • There are 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.

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.

How Are Itchy Eyes Treated?

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

  • If allergies are the culprit, antihistamine eye drops or oral antihistamines can provide relief. Examples of antihistamine eye drops include Ketotifen and Olopatadine.

  • Administration of steroid injections around the eyes.

  • If dryness is causing the itchy eyes, over-the-counter artificial tears (lubricating eye drops) can help moisturize and soothe the eyes.

  • If a person knows the specific allergen triggering the symptoms (e.g., pollen, pet dander), try to minimize exposure. Keep windows closed during high pollen seasons and keep the living space clean.

  • Patients with long-term corticosteroids are also prescribed antibiotic drops to prevent superinfection.

  • If the itching is due to blocked oil glands, like meibomian gland dysfunction, a warm compress can help unclog the glands and improve eye comfort.

Is It Possible to Manage Itchy Eyes with Home Remedies?

Patients can adopt several self-help measures to manage itchy eyes. However, persistently itchy eyes require specialist attention.

Some of the itchy eyes home remedies are

  • 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.

  • 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.

Can Itchy Eyes Be Prevented?

Itchy eyes 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.

  • Rubbing itchy eyes must be prevented, as rubbing already irritated eyes can increase allergens like pollen and pet dander. Rubbing itchy eyes can damage the top corneal layer, resulting in pain and infection.

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 corticosteroids are prone to superinfections. Hence, patients with itchy eyes require long-term follow-up.

Why Do People Have Dry Eyes at Night?

Many people experience dry eyes at night. Dry eyes at night can be prevented by wearing sunglasses, which help protect from smoke, wind, and dry air, which are the main factors contributing to dry eyes at night. Frequent blinking and regular breaks from screen time can also help manage this condition.

Conclusion

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

Dr. Gargi Madhukar Apte
Dr. Gargi Madhukar Apte

Ophthalmology (Eye Care)

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