treatment of allergic conjunctivitis

Last reviewed 01/2018

Management principles:

• avoidance of allergen if known
  
  
• topical antihistamines may be useful, oral antihistamines do not have a role (1)
  • eye drops of antihistamines such antazoline (with xylometazoline as Otrivine-Antistin®), azelastine, epinastine, ketotifen and olopatadine may be used for allergic conjunctivitis
  • not a therapeutic option that is appropriate for prolonged use (no longer than six weeks)
  • not an appropriate treatment option in contact dermatoconjunctivitis
    
    
• oral antihistamines such as loratadine or chlorphenamine may be used
  • especially useful when there is associated allergic rhinitis
  • can cause drowsiness, especially the older compounds such as chlorphenamine - patients need to be cautioned regarding this
    
    
• other possible preparations include:
  • sodium cromoglicate (sodium cromoglycate) and nedocromil sodium eye drops - these preparations can be useful for vernal keratoconjunctivitis and other allergic forms of conjunctivitis
  • lodoxamide eye drops - this preparation may be used for allergic conjunctival conditions including seasonal allergic conjunctivitis
  • diclofenac eye drops and emedastine eye drops are also licensed for seasonal allergic conjunctivitis
    
    
• in general, corticosteroid containing ointments or drops should be avoided unless the prescriber is able to monitor accurately for adverse effects (1) e.g. glaucoma, cataract - only used where there is no doubt about the diagnosis
  
  
• oral corticosteroid therapy
  • a short (five-day) course may be used in severe cases where there is no doubt about the diagnosis
  • ophthalmologists may use oral steroids in severe cases of allergic conjunctivitis

Reference:

1. Prescribers' Journal 2000; 40 (2): 130-137.
2. BNF 11.4.2
3. Azari AA, Barney NP; Conjunctivitis: a systematic review of diagnosis and treatment. JAMA. 2013 Oct 23;310(16):1721-9.