Management of chronic allergic eye disease

Ocular allergies, like systemic allergies, can vary in severity, and medical treatment should be adjusted accordingly.

First-line options such as allergen avoidance, cool compresses, preservative-free lubricating eye drops, and over-the-counter medications like mast-cell stabilizers, antihistamines, and combination eye drops are a reasonable approach to seasonal or intermittent allergic conjunctivitis that responds well to management.¹

More severe and recalcitrant cases may require a topical corticosteroid to reduce ocular surface inflammation and symptoms. Although corticosteroids are effective, their long-term use requires caution due to such possible complications as elevated IOP, cataract formation, and increased risk of microbial infection.²

Immunomodulating medications like cyclosporine A and tacrolimus may be used in the long-term for severe and recurrent cases of such allergic eye disease (AED) as vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC).³ In June 2021, the FDA approved cyclosporine 0.1% (Verkazia; Santen Pharmaceutical) for VKC in adolescents and adults. Protopic (tacrolimus) is FDA approved in the second line for atopic dermatitis. Protopic ointment 0.03% is used in patients aged 2 to 15, and both Protopic ointment 0.03% and 0.1% can be used in those 16 years and older.⁴ It is important to keep the ointment on the periocular skin and caution patients to avoid getting it in the eyes.

References

1. Carr W, Schaeffer J, Donnenfeld E. Treating allergic conjunctivitis: a once-daily medication that provides 24-hour symptom relief. Allergy Rhinol (Providence). 2016;7(2):107-114. doi:10.2500/ar.2016.7.0158

2. Liu S, Saldanha IJ, Abraham AG, et al. Topical corticosteroids for dry eye. Cochrane Database Syst Rev. 2022;10(10):CD015070. doi:10.1002/14651858.CD015070.pub2

3. Erdinest N, Solomon A. Topical immunomodulators in the management of allergic eye diseases. Curr Opin Allergy Clin Immunol. 2014;14(5):457-463. doi:10.1097/ACI.0000000000000089

4. FDA. Medication Guide: Protopic. 2006.