Allergic conjunctivitis: Management
- Pedram Hamrah, MD
Pedram Hamrah, MD
- New England Eye Center/Tufts Medical Center
- Tufts University School of Medicine
- Reza Dana, MD, MPH, MSc
Reza Dana, MD, MPH, MSc
- Claes Dohlman Professor of Ophthalmology
- Harvard Medical School
Allergic conjunctivitis is caused by airborne allergens contacting the eye, which leads to immunoglobulin E (IgE)-mediated local mast cell degranulation and allergic inflammation. It typically presents as bilateral ocular pruritus, redness, and watery discharge. This topic discusses the management of allergic conjunctivitis. The clinical manifestations, epidemiology, diagnosis, and differential diagnosis are reviewed separately. (See "Allergic conjunctivitis: Clinical manifestations and diagnosis".)
An overview of conjunctivitis and detailed reviews of other types of conjunctivitis are found elsewhere. (See "Conjunctivitis" and "Vernal keratoconjunctivitis" and "Atopic keratoconjunctivitis" and "Giant papillary conjunctivitis" and "Toxic conjunctivitis".)
Basic eye care — There are several general measures that are helpful to most patients with allergic conjunctivitis:
●Patients should not rub their eyes because rubbing can cause mechanical mast cell degranulation and worsening of symptoms.
●Cool compresses can help reduce eyelid and periorbital edema .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Bilkhu PS, Wolffsohn JS, Naroo SA, et al. Effectiveness of nonpharmacologic treatments for acute seasonal allergic conjunctivitis. Ophthalmology 2014; 121:72.
- Spector SL, Raizman MB. Conjunctivitis medicamentosa. J Allergy Clin Immunol 1994; 94:134.
- Abelson MB, Allansmith MR, Friedlaender MH. Effects of topically applied occular decongestant and antihistamine. Am J Ophthalmol 1980; 90:254.
- Stiehm ER, Ochs HD, Winkelstein JA. Immunodeficiency disorders: General considerations. In: Immunologic disorders in infants and children, Stiehm ER, Ochs HD, Winkelstein JA (Eds), Elsevier Saunders, Philadelphia 2004. p.423.
- Berdy GJ, Smith LM, George MA. The effects of disodium cromoglycate in the human model of acute allergic conjunctivitis. Invest Ophthalmol Vis Sci 1989; 30 Suppl:503.
- Nizami RM. Treatment of ragweed allergic conjunctivitis with 2% cromolyn solution in unit doses. Ann Allergy 1981; 47:5.
- Greiner JV, Michaelson C, McWhirter CL, Shams NB. Single dose of ketotifen fumarate .025% vs 2 weeks of cromolyn sodium 4% for allergic conjunctivitis. Adv Ther 2002; 19:185.
- Guest JF, Clegg JP, Smith AF. Health economic impact of olopatadine compared to branded and generic sodium cromoglycate in the treatment of seasonal allergic conjunctivitis in the UK. Curr Med Res Opin 2006; 22:1777.
- Tinkelman DG, Rupp G, Kaufman H, et al. Double-masked, paired-comparison clinical study of ketorolac tromethamine 0.5% ophthalmic solution compared with placebo eyedrops in the treatment of seasonal allergic conjunctivitis. Surv Ophthalmol 1993; 38 Suppl:133.
- Yaylali V, Demirlenk I, Tatlipinar S, et al. Comparative study of 0.1% olopatadine hydrochloride and 0.5% ketorolac tromethamine in the treatment of seasonal allergic conjunctivitis. Acta Ophthalmol Scand 2003; 81:378.
- Discepola M, Deschenes J, Abelson M. Comparison of the topical ocular antiallergic efficacy of emedastine 0.05% ophthalmic solution to ketorolac 0.5% ophthalmic solution in a clinical model of allergic conjunctivitis. Acta Ophthalmol Scand Suppl 1999; :43.
- Schleimer RP. Effects of glucocorticosteroids on inflammatory cells relevant to their therapeutic applications in asthma. Am Rev Respir Dis 1990; 141:S59.
- Druzgala P, Wu WM, Bodor N. Ocular absorption and distribution of loteprednol etabonate, a soft steroid, in rabbit eyes. Curr Eye Res 1991; 10:933.
- Abelson MB, Welch DL. An evaluation of onset and duration of action of patanol (olopatadine hydrochloride ophthalmic solution 0.1%) compared to Claritin (loratadine 10 mg) tablets in acute allergic conjunctivitis in the conjunctival allergen challenge model. Acta Ophthalmol Scand Suppl 2000; :60.
- Spangler DL, Abelson MB, Ober A, Gotnes PJ. Randomized, double-masked comparison of olopatadine ophthalmic solution, mometasone furoate monohydrate nasal spray, and fexofenadine hydrochloride tablets using the conjunctival and nasal allergen challenge models. Clin Ther 2003; 25:2245.
- Crampton HJ. Comparison of ketotifen fumarate ophthalmic solution alone, desloratadine alone, and their combination for inhibition of the signs and symptoms of seasonal allergic rhinoconjunctivitis in the conjunctival allergen challenge model: a double-masked, placebo- and active-controlled trial. Clin Ther 2003; 25:1975.
- Ousler GW 3rd, Workman DA, Torkildsen GL. An open-label, investigator-masked, crossover study of the ocular drying effects of two antihistamines, topical epinastine and systemic loratadine, in adult volunteers with seasonal allergic conjunctivitis. Clin Ther 2007; 29:611.
- Schoeneich M, Pécoud AR. Effect of cetirizine in a conjunctival provocation test with allergens. Clin Exp Allergy 1990; 20:171.
- Bronsky EA, Falliers CJ, Kaiser HB, et al. Effectiveness and safety of fexofenadine, a new nonsedating H1-receptor antagonist, in the treatment of fall allergies. Allergy Asthma Proc 1998; 19:135.
- Ciprandi G, Buscaglia S, Pesce GP, et al. Protective effect of loratadine on specific conjunctival provocation test. Int Arch Allergy Appl Immunol 1991; 96:344.
- Lanier BQ, Abelson MB, Berger WE, et al. Comparison of the efficacy of combined fluticasone propionate and olopatadine versus combined fluticasone propionate and fexofenadine for the treatment of allergic rhinoconjunctivitis induced by conjunctival allergen challenge. Clin Ther 2002; 24:1161.
- Lobefalo L, D'Antonio E, Colangelo L, et al. Dry eye in allergic conjunctivitis: role of inflammatory infiltrate. Int J Immunopathol Pharmacol 1999; 12:133.
- Fukushima A, Ohashi Y, Ebihara N, et al. Therapeutic effects of 0.1% tacrolimus eye drops for refractory allergic ocular diseases with proliferative lesion or corneal involvement. Br J Ophthalmol 2014; 98:1023.
- Wan KH, Chen LJ, Rong SS, et al. Topical cyclosporine in the treatment of allergic conjunctivitis: a meta-analysis. Ophthalmology 2013; 120:2197.
- Erdinest N, Solomon A. Topical immunomodulators in the management of allergic eye diseases. Curr Opin Allergy Clin Immunol 2014; 14:457.
- Pregnancy and Lactation Labeling Final Rule: http://www.fda.gov/Drugs/DevelopmentApprovalProcess/DevelopmentResources/Labeling/ucm093307.htm (Accessed on January 29, 2015).
- INITIAL MEASURES
- Basic eye care
- Allergen avoidance
- OVERVIEW OF THERAPIES
- Topical therapies
- - Vasoconstrictor/antihistamine combinations
- - Antihistamines with mast cell-stabilizing properties
- - Mast cell stabilizers
- - Nonsteroidal antiinflammatory drugs
- - Glucocorticoids
- Use of multiple eye drops
- Systemic therapies
- - Oral antihistamines
- TREATMENT FOR SPECIFIC DISORDERS
- Acute allergic conjunctivitis
- - Anticipated exposures
- - Frequent episodes
- Seasonal and perennial allergic conjunctivitis
- - Preferred agents
- - Patients with concomitant rhinitis
- REFRACTORY SYMPTOMS
- Concomitant dry eyes
- Concomitant toxic conjunctivitis
- Need for more aggressive therapy
- SPECIAL POPULATIONS
- Pregnant women
- Young children
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS