Treatment Options for Allergic Conjunctivitis

First-Line Treatments

The American Academy of Ophthalmology recommends wearing sunglasses to create a barrier against airborne allergens 1
Applying cold compresses can reduce inflammation and provide symptomatic relief 3
Using refrigerated artificial tears can dilute allergens and inflammatory mediators 4
Avoiding eye rubbing is crucial as it can worsen symptoms and potentially lead to keratoconus 1
Implementing allergen avoidance strategies, including hypoallergenic bedding and frequent clothes washing, can help alleviate symptoms 2
Over-the-counter topical antihistamine/vasoconstrictor agents can be used for mild allergic conjunctivitis 1
Second-generation topical histamine H1-receptor antagonists are more effective for mild allergic conjunctivitis 3, 4

A brief course (1-2 weeks) of topical corticosteroids with low side-effect profiles can be used for inadequately controlled symptoms 1, 4
Baseline and periodic measurement of intraocular pressure (IOP) is necessary when using corticosteroids 1
Pupillary dilation to evaluate for cataract formation is recommended when using corticosteroids 2
Monitoring for glaucoma is crucial, especially with prolonged use of corticosteroids 4

Cooled preservative-free artificial tears can alleviate coexisting tear deficiency and dilute allergens 1, 2
Oral antihistamines may be used but can potentially worsen dry eye syndrome 4
Topical mast-cell inhibitors can help alleviate associated allergic rhinitis symptoms 1

Topical cyclosporine or tacrolimus can be used for severe cases 1, 2
Allergen-specific immunotherapy (subcutaneous or sublingual) can be used for patients with inadequate control with topical medications 3

Treatment for vernal/atopic conjunctivitis follows a similar stepwise approach as seasonal allergic conjunctivitis 2
Supratarsal injection of corticosteroid may be considered for severe sight-threatening cases unresponsive to topical therapy 2, 5
Avoiding punctal plugs is recommended as they prevent flushing of allergens and inflammatory mediators 3
Monitoring for keratoconus is crucial in patients with allergic conjunctivitis, especially with persistent eye rubbing 1
Consultation with an allergist or dermatologist may be beneficial for patients with difficult-to-control disease 3