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Itchy eyes are a common and very bothersome symptom, and usually not a dangerous one. The difficulty is that several different conditions cause it, and the treatment for each of them is different. On this page we explain how to tell the common causes apart, why rubbing makes things worse, and what an eye doctor checks when the itching keeps coming back.
When to see a doctor straight away: pain in the eye (not just itching); strong sensitivity to light; a drop in vision or blurring that does not clear with blinking; one red eye with discharge; swelling that spreads around the eye, especially with a fever; itching that started after an eye injury or after a chemical got into the eye (rinse immediately with running water and go to the emergency department); contact lens wearers with redness and pain (take the lenses out and get seen the same day).
Why do the eyes itch?
Itching is a signal that the sensory nerves in the eyelids and the conjunctiva (the clear membrane that covers the white of the eye) send when something irritates them. The irritation can come from an allergic reaction, from inflammation of the eyelid margins, from an unstable tear film or from a substance that comes into contact with the eye. In practice, quite a few people have more than one cause at the same time, so it is worth paying attention to the details: where exactly it itches, when it gets worse, and what comes with the itching.
The common causes and how to tell them apart
Eye allergy (allergic conjunctivitis)
In allergy, itching is usually the most prominent symptom. It appears in both eyes, is felt especially in the inner corner, and comes with watery tears, redness and sometimes swollen eyelids. Sometimes there is a clear, sticky, stringy discharge. The itching gets worse in certain seasons and around animals, dust or plants, and often comes together with a runny nose and sneezing.
When it is allergy, the eye doctor may recommend anti-allergy drops and ways to reduce exposure to whatever triggers it. Note that some allergy medicines taken by mouth can increase dryness of the eyes.
Blepharitis and Demodex
Blepharitis is inflammation of the eyelid margins. Here the itching is felt along the eyelid margins and at the base of the lashes, not in the whole eye. It tends to be stronger in the morning, and comes with red eyelid margins, scales or crusts on the lashes and a sticky feeling. Sometimes the lashes fall out or grow in different directions.
In some people the Demodex mite, a tiny parasite that lives in the lash follicles, is involved. A typical sign of it is scales that wrap around the base of the lash like a sleeve. According to professional reviews, Demodex is linked to recurrent blepharitis and to itching along the eyelid margins, although it is also found in people without symptoms. More about the mite, the examination and the treatment on the Demodex in the eyelids page.
Dry eye and the meibomian glands
In dryness, the itching usually comes mixed with burning, a gritty feeling, tired eyes and blurring that improves with blinking. It gets worse in front of screens, in air conditioning and towards the evening. Often the cause is meibomian glands (tiny oil glands in the eyelid margins) that do not secrete properly, so the tears evaporate too quickly (MGD). When burning is more prominent than itching, also read the page on burning eyes.
Contact lenses and preservatives in drops
Contact lenses, especially when worn for long hours, can irritate the surface of the eye and the inner side of the upper eyelid. Preservatives in eye drops, especially with frequent use, can also cause irritation and itching. Sometimes the drops that are supposed to bring relief are part of the problem, and switching to preservative-free drops may help.
The skin around the eyes
The skin of the eyelids is thin and sensitive. A reaction to make-up, cream, hair dye or another substance that comes into contact with the eyelids, as well as general skin diseases, can cause itching, redness and flaking of the eyelid skin. In this situation it is worth stopping any new product and getting examined, by an eye doctor or a dermatologist as needed.
Clues that help point the way
No single clue is enough for a diagnosis, but a few simple questions help you and the doctor point in the right direction:
- Where does it itch? Itching in the inner corner of the eye and in the whole eye fits allergy better. Itching along the eyelid margins and at the base of the lashes fits blepharitis and Demodex better.
- When does it get worse? Strong itching in the morning, right after waking up, suggests the eyelid margins. Itching and burning that get worse towards the evening and in front of screens fit dryness better. Itching that appears in certain seasons or around animals fits allergy.
- What comes with it? A runny nose and sneezing point to allergy. Scales and crusts on the lashes point to blepharitis. A gritty feeling and blurring that improves with blinking point to dryness.
- One eye or both? Allergy, dryness and blepharitis usually affect both eyes. Itching and redness in one eye only, especially with discharge, warrant a quicker examination.
Why rubbing makes the itching worse
Rubbing the eyes brings relief for a moment, but it releases more substances in the eye that trigger itching and redness, and so a cycle forms: it itches, you rub, and it itches even more. Rubbing also irritates the eyelid margins and can make blepharitis worse. Hard, frequent rubbing over a long period is not good for the cornea (the clear window at the front of the eye) and is linked to keratoconus, so it is best to avoid it even when that is difficult.
Until the examination, a cold compress on the closed eyes and preservative-free lubricating drops may bring relief. If you wear contact lenses, it is worth giving your eyes a break from them.
What the eye doctor checks
The slit lamp examination (a microscope that shows the front of the eye under magnification) helps tell the causes apart, because each one has its own signs:
- The eyelid margins and the base of the lashes: redness, scales, and sleeve-shaped scales that suggest Demodex.
- If needed, examining a lash under a microscope to look for Demodex.
- The openings of the meibomian glands and the quality of the oil they secrete.
- The conjunctiva, including the conjunctiva under the upper eyelid, where allergy sometimes leaves small bumps.
- Tests of the tear film, such as the tear break-up time and staining of the eye surface. See dry eye tests.
It is worth bringing to the examination a list of the drops and medicines you use, and telling the doctor when the itching gets worse and what you have already tried.
What may help when the itching is linked to the eyelids
When the examination shows that the itching comes from blepharitis, Demodex or the meibomian glands, treatment focuses on the eyelid margins. The basis is daily care at home: gentle cleaning of the eyelid margins and warm compresses as instructed by the doctor. When that is not enough, there are clinic treatments that may help some patients:
- Eyelid margin cleaning with BlephEx, which removes scales and a layer of bacteria from the base of the lashes.
- Meibomian gland expression, when the glands are blocked.
Blepharitis is usually a chronic condition, so the aim is to reduce the symptoms and the flare-ups over time, not a one-off cure. When there is also allergy, it is treated at the same time, as recommended by the eye doctor.
When to book an examination
It is worth getting examined if the itching keeps coming back, if it does not improve after a few weeks of basic care, if there are scales or crusts on the lashes, or if the itching comes with burning and dryness that interfere with daily life. A proper examination helps work out the cause, and choose a treatment that suits it instead of trying different drops without direction.
Want a basic explanation first?For basic information on eyelid hygiene: the guide on the Mitzmutz site
Frequently asked questions
How can I tell if itchy eyes are caused by allergy?
In allergy, the itching usually appears in both eyes, is most marked in the inner corner, gets worse in certain seasons or around animals and dust, and often comes with tearing, a runny nose and sneezing. When the itching is concentrated along the eyelid margins and at the base of the lashes and is stronger in the morning, blepharitis should also be considered. Sometimes both are present, and an examination by an eye doctor helps tell them apart.
Can itchy eyes be caused by dry eye?
Yes. In dryness, the itching usually comes together with burning, a gritty feeling and tired eyes, and tends to get worse in front of screens and towards the evening. When lubricating drops do not help, it is worth checking whether there is also inflammation of the eyelid margins or a problem with the meibomian glands.
Why should I not rub my eyes when they itch?
Rubbing releases more substances in the eye that increase the itching and the redness, so it brings relief for a moment and makes things worse afterwards. Hard, frequent rubbing over a long period is also not good for the cornea, and is linked to keratoconus.A cold compress and rinsing with lubricating drops may bring relief until the examination.
What is Demodex, and how do I know if I have it?
Demodex is a tiny mite that lives in the lash follicles. In some people it is linked to itching along the eyelid margins and to recurrent inflammation. The eye doctor identifies it by typical sleeve-shaped scales around the base of the lashes, and sometimes by examining a lash under a microscope.
Home care not enough? We can look into it.
At the dry eye clinic in Haifa we find out what is causing the dryness and build a personal treatment plan.
Sources
- Amescua G, Akpek EK, Farid M, et al. Blepharitis Preferred Practice Pattern®. Ophthalmology. 2019;126(1):P56-P93.
- Liu J, Sheha H, Tseng SC. Pathogenic role of Demodex mites in blepharitis. Curr Opin Allergy Clin Immunol. 2010;10(5):505-510.
- Craig JP, Nichols KK, Akpek EK, et al. TFOS DEWS II Definition and Classification Report. Ocul Surf. 2017;15(3):276-283.
- Baudouin C, Labbé A, Liang H, Pauly A, Brignole-Baudouin F. Preservatives in eyedrops: the good, the bad and the ugly. Prog Retin Eye Res. 2010;29(4):312-334.
- Cronau H, Kankanala RR, Mauger T. Diagnosis and management of red eye in primary care. Am Fam Physician. 2010;81(2):137-144.
The information on this site is general only. It is not medical advice and does not replace an examination by an eye doctor.