This entity is well known in the spring and fall: watery, itchy eyes, often with mucoid discharge and usually seen in patients with other allergic conditions such as chronic allergic rhinitis, asthma or contact dermatitis. This condition is invariably bilateral: a unilateral red eye with a clear watery discharge should raise suspicion for herpes simplex conjunctivitis and /or keratitis or corneal abrasion or foreign body. A purulent discharge usually indicates bacterial infection which often occurs in patients with ocular surface disease such as allergic conjunctivitis. Antibiotics are ineffective in pure allergic conjunctivitis and often worsen symptoms, particularly when aminoglycosides are used as the patient is often allergic to the eyedrop.
Naphcon-A, a combined topical antihistamine and vasoconstrictor is now OTC and is inexpensive: it is a good first line agent for mild allergic conjunctivitis. Alomide is a mast cell stabilizer but must be used daily for 7- 10 days for any significant effect and is thus best reserved for chronic, fairly severe cases. Patanol, which has both immediate antihistamine properties and longer-term mast cell stabilization, is useful for patients with significant symptoms. This drug is fairly expensive and must be used daily (BID) and regularly for best results. Oral antihistamines such as Zyrtec are effective in about two thirds of patients and are good agents for younger children in whom installation of eyedrops is a real chore.