Treatment should be adjusted based on disease severity.
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.