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Eye Allergies in Children

Parenthood Magazine August'13 issue




EYE ALLERGIES IN CHILDREN
A Brief Overview of Eye Allergies in Children

Definition : It is an allergic reaction of the eyes characterized by inflammation of
                     the conjunctiva, a thin membrane that covers the inside of the eyelids 
                     and the eye. In medical term it is called as allergic conjunctivitis.
Symptoms : Itchiness
                      Redness
                      Watery eyes
                      Frequent rubbing
                      Swelling of eyelids
                      Eye discharge- mucous, sticky
                    
Signs :  Redness                                  
             Swollen lids
            Ropy mucous discharge
             Corneal involvement
             Papillae on eyelids (Figure 1)
             Trantas dots (Figure 2)
            

Treatment:  Anti-allergy eyedrops
                      Artificial tears
                      Steroid eyedrops- in severe condition
                      Antibiotic eyedrops – if concurrent infection is present
                      Tablet antihistamine


Eye allergies are the second most common condition encountered among Paediatric patients in my daily practice after refractive error. These are the frequently asked questions by the parents:
1.    Why my child has eye allergies? What is the cause?
Children with eye allergies also have tendency to develop other allergic condition such as nose allergy (allergic rhinitis), skin allergy (atopic dermatitis) or bronchial asthma. Common triggers of eye allergies are pollen, dust, animal danders and dust mites. Occasionally food or food additives can also precipitate.

2.    How to prevent the eye allergy attack?
Keep your child away from the allergic triggers. In order to do that you need to know what are the things that your child is allergic to. A skin test to determine the triggering substance can be carried out. In terms of treatment, some children may benefit from cold compresses on the eyes and regular use of artificial tear eyedrops which can flush away the debris on the ocular surface.

3.    How long should my child use the eyedrops?
The duration of treatment will depend on the severity of the condition. Any acute episode of allergic conjunctivitis need to be treated first, which commonly involve anti-allergy, steroid and antibiotic eyedrops. After the acute episode has settled, the treatment goal is to maintain and prevent any recurrent attack.

4.    What are the possible complications of eye allergy?
Eye allergies rarely will give rise to any serious complications but the recurring attack will affect your child’s daily activity and quality of life. Keratitis, an inflammation of the cornea can occur. Cornea is a clear layer at the front of the eye and if it is inflammed, this is painful and can cause photophobia ( increase sensitiveness to the light). This condition is irritating and can affect your child’s school performance. The two complications that may lead to visual loss are corneal ulcer and keratoconus.  Ulcer can form on the cornea (Figure 3) and if it heals with scar the vision may be permanently affected. Keratoconus is the result of chronic rubbing causing progressive thinning of the cornea and protrusion of the cornea. This can cause irregular astigmatism and affect the vision.  

5.    Are steroid eyedrops safe for my child?
Steroid eyedrop is known to have side effects to the eye such as glaucoma and cataract. But in an acute and severe attack of allergic conjunctivits, steroid eyedrop is needed to suppress the inflammation. Therefore the use of steroid eyedrops in children is safe as long as they are frequently monitored by the ophthalmologist.

6.    How frequent does my child need to come for follow up?
The frequency of the follow up will depend on the severity of the condition. Once the acute episode resolved, at least a 6 monthly follow up is required. If the child is free from any allergy attack and not depending anymore on the medication for at least one year, then follow up is only on necessary basis.