Red, Itchy Eyes Are Year Round in Hawaii

There are so many advantages to living in Hawaii – the sun, the outdoor sports, the sense of ohana.

October in Hawaii! And, just a few blocks from our house on a public access beach – can’t beat that!

But, one thing which is not better here than on the mainland is the ALLERGIES!  I have lived in many places – North Carolina, Boston, New York – and my allergies are the absolute worst here in Hawaii.  This year seems to have hit allergy sufferers particularly hard – you may recognize the signs of hay fever – runny nose, clogged sinuses, headaches, coughing and sneezing. One-third of individuals who suffer from allergies also have ocular allergies – dry, itchy and red eyes. Allergic conjunctivitis occurs when the clear layer of tissue lining the eyelids and the white covering of the eyes, becomes inflamed. This causes tearing, discharge (makapiapia), itching, and redness. The most common cause of these symptoms is pollen during hay fever season, however, there are many allergens which can trigger symptoms year round. Cockroaches, dust mites, and animal fur or hair are just a few examples of triggers for sensitive individuals.

Symptoms of allergic conjunctivitis

  • tearing
  • discharge
  • itching 
  • redness


A severe type of allergic conjunctivitis is called vernal conjunctivitis.  On the mainland, this usually only happens during summer and spring, but here in Hawaii, I see it year round.  So, these poor kids not only suffer from the redness, tearing, itching of typical allergy sufferers, but additional complaints.

Symptoms of vernal conjunctivitis

  • light sensitivity
  • thick pus like discharge
  • bumpy growths on the clear part of the eye or underneath the eyelid
Bumps on the pink part of the lower lid (conjunctiva), also known as papillae
Bumps on the pink part of the lower lid (conjunctiva), also known as papillae

I had one child from Maui who came in because her eye doctor that she needed eyelid surgery for a droopy eyelid.  I could barely examine the poor girl.  She was so light sensitive, she kept her right eye shut constantly and her vision was also terrible in that eye.
Screen Shot 2015-11-03 at 9.07.40 AM
Once I actually was able to flip her upper lid, I saw this.
Screen Shot 2015-11-03 at 9.06.28 AM
Huge bumps underneath her eyelid, just like in vernal conjunctivitis.
So, we started her on treatment.  The most common treatment for vernal conjunctivitis is:

  • Oral antihistamines (Claritin, Zyrtec)
  • Antihistamine drops (Pazeo, Padatay, Lastacaft)
  • Steroid drops to reduce swelling and redness (lotemax, prednisolone acetate, durezol)
  • Cold compresses
  • Avoidance of the allergen

She was also tested for allergies.  Turns out that she was allergic to dogs and cats and she had been visiting her grandmother’s farm every weekend which had tons of animals.  We reduced her visits to the farm, gave her Pataday and lotemax and several weeks later…
Screen Shot 2015-11-03 at 12.55.37 PMHer vision improved to a perfect 20/20 and she was able to open the eye again.   No surgery needed to elevate that upper lid. This was the only dog she could have now – but at least she could see!
Though classic teaching regarding vernal is that it mainly occurs during spring and summer months, I do see it year round here in Hawaii.  And, I can tell when allergens getting bad because all of my patients with vernal conjunctivitis will flare and make appointments in the same few weeks!  The most common allergens in Hawaii are dust mites, mold and cockroaches.  I lived in NYC for 8 years, I thought I was cool with roaches.  But, I tell you, NYC has nothing on Hawaii in terms of the sizes of our cockroach.  It was one of the deals I made with my husband before I moved here – he had to kill all of the roaches.  He gets super annoyed when I wake him up at midnight to tackle yet another flying roach (and I swear our house is clean!).  But a deal is a deal!

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Dr. Rupa Wong


Hi! I'm Dr. Rupa Wong. Physician. Private Practice Owner. Mama to 3 kids. Managing Partner. Educator. Textbook Author. Conference Co-Founder. Mentor. I am more than just one thing, even as a doctor and I bet you are too. I would love to help you envision the life you want, and then get after it. What are you waiting for?

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