Spring eye allergy: recognising and relieving the symptoms

Runny nose, red eyes and watering as soon as the warm weather returns? Seasonal allergic conjunctivitis affects a growing share of the French population. Fortunately, effective treatments exist, provided that other causes of a red eye warranting an ophthalmological opinion are ruled out.

Contents

UNDERSTANDING

Understanding seasonal allergic conjunctivitis

Seasonal allergic conjunctivitis (SAC) is an inflammation of the conjunctiva triggered by pollens. The mechanism is an immediate hypersensitivity reaction mediated by IgE, with the release of inflammatory mediators (histamine, leukotrienes) by mast cells. It classically occurs between April and June, with a peak driven by grass, birch and cypress pollens.

The symptoms typically combine intense eye itching, watering, diffuse conjunctival redness, a burning sensation and mild eyelid swelling. In most cases, allergic rhinitis is also present, hence the term rhinoconjunctivitis. According to Leonardi et al. (Curr Allergy Asthma Rep, 2024), management with a topical antihistamine significantly improves symptoms and quality of life.

WHEN TO CONSULT

When should you see an ophthalmologist?

Most cases of seasonal allergic conjunctivitis can be managed with a short course of self-administered topical antihistamine treatment. Nevertheless, an ophthalmological consultation is required in several situations:

  • A drop in visual acuity associated with the red eye
  • Purulent discharge (suggestive of infectious conjunctivitis)
  • Eye pain or marked photophobia (keratitis, uveitis)
  • Failure of a well-conducted antihistamine treatment after 5 to 7 days
  • Recurrent episodes or symptoms lasting all year round (possible vernal or atopic keratoconjunctivitis)
  • Associated contact lens wear

In children and adolescents, certain severe forms (vernal keratoconjunctivitis, VKC) can lead to corneal complications. A precise differential diagnosis using a slit lamp remains essential to tailor the treatment.

SOLUTIONS

Available solutions

The treatment strategy is graduated according to severity and the impact on daily life:

  • Avoidance measures: wraparound sunglasses, regular hand and face washing after exposure, saline rinses, keeping windows closed during pollen peaks.
  • Eye washing with cold saline solution: several times a day, using single-dose saline kept in the refrigerator. Washing mechanically removes allergens (pollens, dust) present on the surface of the eye, and the cold temporarily soothes the itching through a vasoconstrictor effect.
  • Second-generation topical antihistamines: olopatadine, ketotifen, epinastine. Fast-acting, with a dual antihistamine and mast-cell-stabilising effect. According to Tariq (Life, 2024), they are the first-line standard for moderate forms.
  • Oral antihistamines: useful when rhinitis is also present, to be adjusted according to allergy guidelines.
  • Topical ciclosporin (Verkazia®): this local immunomodulating eye drop based on ciclosporin A is indicated as a second-line treatment, particularly in severe vernal keratoconjunctivitis (VKC) in children and adolescents. It is dispensed on specialist prescription. According to Giannaccare et al. (Ophthalmol Ther, 2023), its use in everyday practice in children with VKC shows clinical improvement and good tolerability, in addition to or as a replacement for topical corticosteroids.
  • Topical corticosteroids: reserved for severe forms, on ophthalmological prescription with monitoring (risk of raised eye pressure, cataract).
  • Allergen-specific immunotherapy: considered by the allergist for persistent, disabling forms.

An ophthalmological consultation makes it possible to rule out differential diagnoses (dry eye, blepharitis, infectious conjunctivitis, anterior uveitis) and to personalise treatment. In contact lens wearers or atopic patients, particular vigilance is needed regarding the risk of chronic eye rubbing, which has been identified as a risk factor for keratoconus.

PREVENTION

Caution: repeated rubbing exposes you to keratoconus

Allergic itching naturally leads people to rub their eyes, sometimes dozens of times a day. This seemingly harmless gesture places repeated mechanical stress on the cornea. According to Sahebjada et al. (Graefe’s Arch Clin Exp Ophthalmol, 2021), chronic eye rubbing has been identified by a systematic review and meta-analysis as a major risk factor for keratoconus, a progressive deformation of the cornea that lastingly impairs vision.

This condition occurs more frequently in allergic patients, particularly children and adolescents with vernal keratoconjunctivitis. It may require specialised treatments (corneal cross-linking, rigid lenses, or even a corneal transplant in advanced forms).

In young adults as well as in children, any allergic patient who frequently rubs their eyes should undergo an ophthalmological examination with corneal topography to screen for the possible onset of keratoconus. Early management of the allergy — and education about not rubbing — is an essential preventive measure.

Early treatment helps stabilise the cornea

When keratoconus is detected at an early or progressive stage, a treatment called corneal cross-linking may be offered. It involves strengthening the structure of the corneal collagen through the combined application of riboflavin (vitamin B2) and ultraviolet A light, in order to slow the progression of the deformation. According to Hafezi et al. (Prog Retin Eye Res, 2025), this procedure can lastingly stabilise the cornea in most cases, provided it is carried out early enough in the course of the disease. It does not improve existing vision, but it preserves future visual capital.

CARE PATHWAY

The care pathway

Dr Tourabaly sees patients at his practice in Cachan (94) for the assessment of allergic conjunctivitis. The consultation includes a slit-lamp examination, a search for associated signs (blepharitis, dry eye syndrome) and a fluorescein test to screen for corneal involvement. An allergy work-up can be arranged in collaboration with a community allergist if the symptoms are disabling or chronic.

To book an appointment, you can call the practice on 01 45 47 08 11 or book directly on Doctolib.

Dr Tourabaly’s view

“Every spring I see patients who play down their allergic conjunctivitis and rub their eyes several times a day. This repeated gesture should be taken seriously: it contributes to weakening the cornea. Suitable treatment quickly relieves the symptoms and protects the cornea in the long term. If your eyes stay red for more than a week despite over-the-counter eye drops, come in for a consultation.”

FAQ

Frequently asked questions

If the symptoms persist for more than 7 to 10 days despite a well-conducted topical antihistamine, or in the event of a drop in visual acuity, eye pain, marked photophobia or purulent discharge, an ophthalmological consultation is required. In contact lens wearers, any conjunctivitis should prompt a rapid assessment.

It is preferable to stop wearing contact lenses during the acute phase. Allergens and inflammatory mediators concentrate on the lens, worsening the symptoms and increasing the risk of infection. Wearing glasses for 1 to 2 weeks, until the inflammation settles, remains the most suitable option.

For mild forms, over-the-counter topical antihistamines (ketotifen) provide rapid relief. For moderate to severe forms, or if there is no improvement after 5–7 days, an ophthalmological prescription may be necessary (olopatadine, epinastine, short courses of corticosteroids). Prolonged self-medication is not advised: it can sometimes mask other causes of a red eye.

A seasonal eye allergy flare-up typically lasts as long as exposure to the offending pollen, often a few weeks in spring. With suitable treatment, symptomatic improvement occurs within 24 to 72 hours. Perennial forms (dust mites, animal dander) can persist all year round and warrant specialist allergy management.

Active allergic conjunctivitis temporarily contraindicates refractive surgery. The procedure will be postponed until the allergy has stabilised, at least 3 to 6 weeks after the last flare-up. An atopic background should be reported during the pre-operative work-up, as it can influence post-laser healing and the choice of technique.

An ophthalmological opinion for your eye allergy

Book an appointment on Doctolib
Learn more — vision assessment

Sources

  1. Leonardi A, Quintieri L, Presa IJ, et al. Allergic Conjunctivitis Management: Update on Ophthalmic Solutions. Curr Allergy Asthma Rep. 2024;24(6):347-360. PMID 38869807
  2. Tariq F. Allergic Conjunctivitis: Review of Current Types, Treatments, and Trends. Life (Basel). 2024;14(6):650. PMID 38929634
  3. Giannaccare G, Rossi C, Borselli M, et al. Clinical Outcomes of Topical 0.1% Ciclosporin Cationic Emulsion Used on Label in Children with Vernal Keratoconjunctivitis. Ophthalmol Ther. 2023;12(3):1787-1793. PMID 37043141
  4. Sahebjada S, Al-Mahrouqi HH, Moshegov S, et al. Eye rubbing in the aetiology of keratoconus: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol. 2021;259(8):2057-2067. PMID 33484296
  5. Hafezi F, Kling S, Hafezi NL. Corneal cross-linking. Prog Retin Eye Res. 2025;104:101322. PMID 39681212

This article is for information purposes. A personalised ophthalmological opinion remains essential for any treatment decision.

See also: Dry eye and remote working, another common disorder of the ocular surface.

Written and reviewed by Dr Moïse Tourabaly, ophthalmic refractive surgeon — former chief resident (Quinze-Vingts National Eye Hospital).

Last updated: July 6, 2026

Similar Posts