Treatment of ocular allergies: nonpharmacologic, pharmacologic and immunotherapy

Abstract

Ocular allergy is a significant and growing issue worldwide but for many patients, it is often not differentiated from systemic conditions, such as hay fever. Management of seasonal and perennial allergic conjunctivitis is often poor. Management is principally through avoidance measures (blocking or hygiene), nonpharmaceutical (such as artificial tears and cold compresses) and pharmaceutical (such as topical antihistamines and prophylactic mast cell stabilizers). Vernal and atopic keratoconjunctivitis are more severe and generally need treatment with NSAIDs, steroids and immunomodulators. Giant papillary conjunctivitis can be related to allergy but also is often contact lens related and in such cases can be managed by a period of abstinence and replacement of the lens or a change in lens material and/or design. Immunotherapy can be efficacious in severe, persistent cases of contact lens or allergic conjunctivitis.

Keywords:

• antihistamine
• atopic keratoconjunctivitis
• giant papillary conjunctivitis
• immunotherapy
• mast cell stabilizer
• ocular allergy
• perennial allergic conjunctivitis
• seasonal allergic conjunctivitis
• vernal keratoconjunctivitis

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Ocular allergy is a significant and growing issue for many patients but is often not differentiated from systemic conditions such as hay fever.

• Management of seasonal allergic conjunctivitis and perennial allergic conjunctivitis is generally poor, with patients often self-medicating and rarely seeking an ophthalmic examination.

• Avoidance of the allergen can be optimized through identification/use of pollen calendars, blocking (such as closing windows, using air conditioning and wearing wrap around spectacles) and hygiene (such as avoid touching/rubbing eyes, hand and hair washing) measures.

• Research evidence for the efficacy of nonpharmaceutical treatments for acute ocular allergy management such as a cold compress and artificial tears is now available although they have not been investigated in more severe vernal keratoconjunctivitis and atopic keratoconjunctivitis.

• The mainstay of pharmaceutical treatment is dual-action antihistamines and mast cell stabilizers because they combine an immediate and prophylactic mode of action.

• NSAIDs, steroids and immunomodulators have a role in more severe disease that is unresponsive to other treatments.

• Immunotherapy can be efficacious in severe, persistent cases of allergic conjunctivitis and those with systemic allergic associations.

• Compliance/adherence is an issue with all topical medication, and the future is likely to see the development of better delivery devices such as pharmaceutical releasing contact lenses.