Ocular Itching and Burning
Ocular Symptoms and Conditions: Itching and Burning
Symptoms of ocular itching and burning are very common. The eye is susceptible to allergies and irritations due to the fact that it is a moist surface constantly in contact with the air, and all of its pollutants. Furthermore, bacteria thrive on moist surfaces, and can cause substantial irritation as well. Some of these bacteria related conditions can progress beyond simple itching, and can lead to a scratchy sensation or even pain.
Other conditions capable of causing eye itching and burning that are discussed on other pages of this Symptom and Diagnosis section are listed below with possible distinguishing features.
Conditions Discussed on this Page:
- Blepharitis
- Ocular Allergy
- Phlyctenulosis
- Other conditions causing ocular itching and burning found on other pages
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Blepharitis
Blepharitis is a non-specific term signifying infection or inflammation of the eyelids. It is a extremely common cause of ocular redness, itching, burning, and generalized irritation. Other symptoms include discharge (especially in the mornings), a scratchy sensation (foreign body sensation), tearing, and temporary blurred vision. The condition tends to involve both eyes.
Blepharitis occurs when bacteria begin to excessively grow at the edge of the eyelid. The margin of the eyelid is a moist surface which is virtually always colonized by one strain of bacteria or another. There are many substances that support the survival of bacteria in that location, including exfoliated skin and oil secretions. People tend to avoid cleaning near the eye which allows material to build up at the base of the eyelashes, further aggravating this problem. Bacteria at the edge of the lids create toxic byproducts which irritate the eye, and the glands of the eyelids themselves can become infected and obstructed.
There are about 30 glands which open at the margin of each eyelid, and these are oil producing glands. Some people have a dysfunction of these glands where the secretion is abnormally thick and becomes trapped in the gland. This creates further irritation and can lead to stye formation. People with the skin condition known as "acne rosacea" tend to have blepharitis and dysfunction of these oil glands.
Treatment of blepharitis involves foremost cleaning of the eyelids. Warm compress can be used to help loosen up debris and thin the oil secretions which bind debris together and obstruct gland openings. There are commercially available kits for eyelid cleansing ("Eyescrub", "Sterilid") which also contain a mild soapy solution or foam and small gauze pads. Some physicians recommend using diluted baby shampoo to clean the eyelid, although this can cause irritation in some people, and care has to be taken not to get soap in the eyes. Artificial tears during the day may help to relieve irritation. Antibiotic ointment can be used on the lids at bedtime to eliminate bacteria. Sometimes antibiotics my mouth are needed. This may be especially useful in rosacea because some antibiotics in the tetracycline family have an oil gland secretion thinning property which can help treat chronic or recurrent blepharitis, and to prevent stye formation. There oral antibiotics have to be taken chronically, although in low dosages. Another alternative effective for many people is taking omega-3 supplements on a long term basis. After about a month of use, the omega-3 supplement leads to a thinner and less inflammatory secretion made by the oil glands.
This condition tends to have relapses, but continued efforts at eyelid cleaning may help to prevent problems.
Ocular Allergy
The eyes are commonly affected by allergy, due to their constant exposure to the environment. Symptoms include itching, redness, lid itching and swelling, mucoid discharge, and eyelid matting in the mornings. There may be an association with hay fever or pollen allergies, with nasal congestion, itching, and running. Oral antihistamines can often relieve ocular symptoms as well. Over-the-counter "allergy" eye drops can be effective, although eye drops which are purely decongestants simply blanch out blood vessels on the surface of the eye. Prescription eye antihistamines may be more effective. Two prescription and two OTC eye drop medications (Pataday, Lastacaft, Zaditor, Alaway) block the release of histamine, have an immediate antihistamine effect, and have an anti-inflammatory effect. Cold compresses on the eyes may help to ease symptoms. Avoidance of the source of the allergic reaction is effective, but may not be possible in all cases. In severe cases, topical or even oral steroids might be required to treat ocular allergies.
The eyes can commonly develop allergies to make-up applied on or near the lids. Any change in eye make-up followed by allergy symptoms may point to this as a cause. Some medications taken by mouth can cause an allergic reaction first seen around the eyes, with swelling and redness of the lids and skin around the eyes. Some eye medications, antibiotics, and glaucoma eye drops, and contact lens solutions can cause allergic reactions as well, some very commonly. The skin around the eyes is very sensitive, and some people will develop an allergic reaction to a cosmetic or hair product that appears around the eyes first, even when the product is not being used around the eyes. One case of this involved a woman who develop a severe allergic reaction to her fingernail polish that appeared only as an ocular allergy.
Some younger people can develop a variant of ocular allergy called "vernal conjunctivitis". This tends to be seasonal, and large lumps develop under the eyelids and can create severe symptoms of itching, lid swelling and droopiness, and discharge. A similar syndrome occurs with contact lens use (see Contact Lens for more information about this).
Phlyctenulosis
Phlyctenulosis (flick-ten-u-low-sis) is a blepharitis related complication of the cornea and conjunctiva. Bacteria at the edge of the eyelids (blepharitis) liberate toxins which spread into the tear layer and irritate the eyes. In this complication, a hypersensitivity reaction, or allergic reaction develops on the cornea or conjunctiva.
Symptoms include ocular redness, itching, burning, tearing, and the sensation that something is in the eye, especially with blinking. Sometimes a white spot can be seen near the edge of the cornea. This spot represents a sterile (non-infected) breakdown of the corneal surface, and can be very irritating.
Treatment is aimed at treating the underlying blepharitis, and at helping the cornea to heal. This condition is very responsive to steroid eye medication. Preventive measures include cleaning of the eyelid in order to prevent the hypersensitivity reaction.
Other Conditions causing ocular itching and burning found on other pages:
A link to each condition is listed along with other hallmark features of the condition.
- Conjunctivitis - "pink eye", with redness, discharge, lid swelling.
- Contact lens problems - contact lens use can cause itching and irritation, due to allergy or improperly fitting lenses.
- Episcleritis - localized eye injection with mild symptoms.
- Medication toxicity - ocular irritation related to eye drop usage.
- Dry eye - sometimes itching is a symptom of dry eye.
- Tearing - conditions that cause tearing often will cause itching due to chronic wetness of the skin around the eyes.
