A contemporary look at allergic conjunctivitis

Abstract

Allergic eye disease is common, yet often overlooked in North America. In the U.S., up to 40% of the population is deemed to be affected and this number is growing. Symptoms and signs of ocular allergy can lead to decreased productivity and negatively impact quality of life (QoL). Various treatment options exist to achieve symptom control. For allergic conjunctivitis, ophthalmic agents include antihistamines, mast cell stabilizers, dual-activity agents, nonsteroidal anti-inflammatory drugs (NSAIDs), steroids and some off-label treatments. Immunotherapy is recommended as a therapeutic option. This review provides a summary of the forms of ocular allergies, with a focus on symptoms and signs, impact on QoL, physical examination, diagnosis and therapeutic options of allergic conjunctivitis. Through multidisciplinary collaborations, a simplified algorithm for the treatment of allergic conjunctivitis is proposed for Canadian clinical practice.

Keywords: Allergic conjunctivitis; Allergic conjunctivitis diagnosis; Allergic conjunctivitis treatment algorithm; Allergic eye disease; Interprofessional management; Ocular allergy.

Fig. 1

Conjunctivitis: Schematic of allergic comorbidities [5, 6]

Fig. 2

Cross-sectional anatomy of the eye [12]

Fig. 3

Ocular signs of (a) chronic perennial allergic conjunctivitis (b–d) acute seasonal allergic conjunctivitis. Reproduced with permission [15]

Fig. 4

Ocular signs of (a) atopic keratoconjunctivitis and (b) vernal keratoconjunctivitis. Reproduced with permission [15]

Fig. 5

Treatment strategies for the management of allergic conjunctivitis

Fig. 6

A simplified approach to the treatment of allergic conjunctivitis

Fig. 7

Interprofessional collaboration—conditions for patient referral to an eye care specialist, a primary care provider (PCP) and an allergist [15]