Question: I can summarize the problems as follows, which I think might be carunculitis or allergic conjunctivitis causing dryness. I am male, 50, athletic.

[1] Last XXXXXXX (2014) regularly had itching and a little watering in the inner corners of the eyes at the caruncles a few times a week. (Had some dandruff or scalp itchiness also but maybe coincidental.) But around late March, eyes flared up and became bloodshot/red and inflamed, spreading out from the inner corner. This faded quickly but ever since it has looked much like the attached picture.

[2] The itching was replaced by a continuous 'flu-like' burning in the corners of the eyes, almost like acid or detergent. Also causing headaches, although not as bad now. All the trouble, pain/discomfort is arising from where the (inflamed) caruncles are pressing on the inner eye; indeed, it almost feels like the caruncles are two small sponges soaking the inner eye with acid or detergent. The rest of the eye feels comfortable however. ALL eye drops make things worse and cause burning at the caruncles with a bloodshot allergic response. Reflex tears or sweat in the corners of the eyes had the same effect.

[3] It may also have affected the tear film or oil glands leading to dryness. My optician told me (some months back) that the tear breakup time is reduced and that it starts to break up mostly from the corners. If I don't blink, again the growing discomfort is in the corners. Still have occasional but slight itchyness at the skin near the inner/outer corners of the eyes. Had this problem now since March. Can't seem to get help. However, had extensive blood work done, inc. thyroid, and everything came back ok. Blood pressure is ok. So probably a local problem due to allergy, skin condition or tear ducts?

[4] Only recently discovered (in Nov) that oral antihistamines (1 Zyrtec daily) relieve quite a lot of the burning/discomfort in the corners. My concern is that these can make dryness worse but I'm drinking 4-5 liters of filtered water daily. Topical antihistamine drops are the only drops I can use without my eyes again burning in the corners and becoming bloodshot. But can use lipid eyelid spray. A cold compress with gel-filled eye mask also helps. Also feels better in cold/wet weather. Scalp still somewhat dry/flaking but using E45 cream and tea tree soap now. Can tolerate reflex tears/sweat in the eyes since taking the antihistamines and hope there has been some healing

[5] Overall health is otherwise very good. I have worked out for decades and have first-rate nutrition, adequate sleep and don't drink alcohol. Taking spinach powder, veg juices, omega 3, astaxanthin etc.etc. This has had a very debilitating effect this year on my life, work, business, plus the stress and anxiety or not knowing exactly what is wrong. But all the trouble is definitely coming out for the corners/caruncles. Any help/advice is greatly appreciated.
Thank you.
XXXX, Phd

Dear Dr Dadpeer K,
Thank you very much for your prompt answer. Given it is allergic conjunctivitis and/or carunculitis, my main concerns are still:

[1] The dryness, tear film disruption and possible eyelid oil gland disruption which I am sure is being caused/driven by the inflammation problems spreading out from the caruncles. (The dryness came about a month later.) I started oral antihistamines (one 10mg Zyrtec daily ) in early Nov. and they have had a positive effect. But I am concerned about being on them for a long period and the increased ocular dryness that could result. However, I am drinking 4-5 liters of filtered water daily and am well hydrated, plus I have overall good health and nutritional support so surely this is not really a major concern? The benefits seem to be outweighing the risks and if allergy/conjunctivitis is causing the dryness then surely this has to be addressed first?

[2] All dry eye drops like Refresh Tears seem to cause an allergic/bloodshot response and burning, again always starting in the corners. However, only a topical antihistamine ('Alaway' )produces no allergic response and is well tolerated and is also lubricating. I know the oral antihistamine is working but not sure what effect the topical AH drops are actually having. However, a lipid eyelid spray like' 'Actimist' also seems to help with dryness without causing any adverse reaction.

[3] Is is also safe to take topical antihistamine drops for long periods, such as several months since they have a BAC preservative? Also, could the corner problems be due to fungal/yeast or local skin problem, and are there other drops or non-steroidal anti-inflammatory drops that could be used or suggested? I see an opthalmologist in person in January. Finally, could it be due to a tear duct problems or inflammation from there? I am keen to find and treat the underlying cause rather than just the symptoms.

[4]I appreciate only a proper face-to face consultation can properly answer these questions, however it will give me much peace of mind to know that despite the months of pain/discomfort, my eyes seem otherwise ok and will gradually get better even if it takes many months. Dealing with worry/depression is the main problem right now. (I'm sure I had something like this back in the 90s but not as severe and it resolved itself within a few weeks.)
Many thanks again.

Thank you again Dr. Just a few more comments:

[1] I am happy with the diagnosis of allergic conj. and/or carunculitis even if it takes months to finally heal. The top picture was taken today, the bottom pictures a few weeks ago, and I think there has been some improvement, even though they are taken in different lighting. With the dry eyedrops it's only at the inflamed caruncles (and very locally where they are touching the inner eye) where there is any intense burning pain/discomfort, and the redness then spreads out from there into the eye and inner lower eyelids (as in the picture) but fades in a few hours. Sweat running into the eye corners had a similar effect. The rest of the eye(s) feels ok. (The flareups over the months have left some permanent veins at the corners, and the sclera covered by the lower eyelid but nothing too noticeable.) Again, there is no problem with AHistamine drops except for a very mild sting that lasts a few seconds.

[2] ALL the trouble/pain is definitely concentrated at the inflamed caruncles where they are touching the eye. The oral AHistamine tablets definitely remove the burning and reduce the redness. A cold compress is also helping. Still a very slight itch occasionally at the skin near the inner and outer eye corners and eyelids, but no more than a minor annoyance. Scalp and forehead is still dry, itchy occasionally and slightly flaking. But good nutrition and consistent hydration is now helping with everything as well I think.

[3] Finally, will any dryness and the tear breakup time improve as the allergic conj. heals and inflammation subsides?If I don't blink, any discomfort begins and grows only at the corners/caruncles. And might the problem actually be due to inflammation/blockage in the tear ducts or sinuses? I've already removed all possible allergy sources such as old carpets, pillows, dust etc.
Thank you again.
Sincerely, XXXX

Dear Dr Dadapeer K,
Thank you for your responses, diagnosis and help. I will continue with antihistamines, cold compresses and nutrition. I will also request a prescription for a non-steroidal anti-inflammatory drop at my appointment in XXXXXXX While there has been some improvement since November, with the antihistamines, can I assume it will yet take some time (months) for everything to respond and finally heal?
Thank you again. XXXX