Often called ocular pruritic, eye itching accompanies a wide range of conditions, both medical and environmental, so pinpointing a single cause is impossible. When the irritation persists beyond short-term status, many causes remain, but the list is shorter.
Eye irritation is a symptom of many diseases of the eye, including several forms of conjunctivitis, as well as some skin conditions. About half of those who have rosacea, a reddening of facial skin, have associated eye problems. Rosacea is typically chronic and persistent itself, commonly recurring for many patients.
Eyelid disease, called blepharitis, may cause persistent irritation, as can conjunctivitis resulting from contact lens use. An oil duct problem called Meibomian gland dysfunction, or MGD, allows the tear layer to evaporate prematurely, resulting in irritation. Aqueous tear deficiencies affect those patients suffering from Sjogren’s syndrome, an autoimmune disorder.
Dry eye syndrome exists on its own and as part of other conditions. For example, contact lens wear problems have several symptomatic factors, of which dry eye syndrome is one. It’s one of the most common contributors to persistent eye irritation.
Dry eye syndrome affects the eyes in one of two ways. When the tear layer of the eye evaporates too quickly, the protective aspects of the layer aren’t sufficient to refresh the eyes. This may be due to reduced tear production or some other factor, such as MGD or slow blinking, that permits the tear layer to dry out.
The other way that dry eye syndrome manifests isn’t necessarily dry at all. In fact, there’s usually an overabundance of tear layer, but its composition is different than in a healthy eye. Typically, the middle component of the tear layer, the salty aqueous portion, over-produces and the excess salt contributes to the persistent irritation.
Frequently inflammatory factors can be detected in the tear film. This is one situation where the use of punctal plugs is contraindicated as increasing the aqueous component worsens the condition and keeps the inflammatory factors present longer and in higher concentration, this creates a vicious cycle whereinflammation becomess chronic and the tear film is totally disrupted.
There is a role for punctal plugs but only once the presence of inflammatory mediators is eliminated.
Treatment depends on the base cause of the irritation. For example, persistent irritation due to allergic reactions may be treated using antihistamines to counteract these reactions, or by removing the allergic irritant from your environment. Antibiotics may clear up bacterial infections that cause the irritation. Anti-inflammatories may be combined with antibiotics where both conditions exist, or used alone if inflammation isn’t related to infection. Tear film underproduction may be augmented with artificial tear therapy. Accurate diagnosis of the base cause is important.
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