Practice Clinical updates

Allergic eye disease

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j4706 (Published 02 November 2017) Cite this as: BMJ 2017;359:j4706
  1. Darshak S Patel,
  2. Meena Arunakirinathan,
  3. Alastair Stuart,
  4. Romesh Angunawela
  1. Moorfields Eye Hospital, London, UK
  1. Correspondence to: D S Patel d.patel1{at}nhs.net

What you need to know

  • Allergic eye disease is usually bilateral and itching is the predominant symptom

  • Uncomplicated disease can be managed in primary care with one or more of cold compresses, lubricants, topical and/or oral antihistamines, and topical mast cell stabilisers

  • Topical and oral steroids and immunomodulatory agents should be prescribed only under the care of an ophthalmologist in refractory cases

Allergic eye diseases include conjunctivitis and occasionally keratitis in response to an allergen. The diseases affect 10%-20% of people globally12 and have a negative impact on quality of life and productivity.3456

Early diagnosis and appropriate treatment is essential to reduce the frequency of relapses, to avoid complications that are potentially sight threatening, and to enhance patient self care. This article provides guidance on recognising the different forms of allergic eye disease and on their management.

Who gets allergic eye diseases?

Children and adolescents are more commonly affected by atopic disease in general, which tends to diminish with age. People with asthma, eczema, and rhinitis often experience concurrent ocular allergy.7 Europe, North America, and Japan report higher prevalence than developing countries.1

How do they present?

Itching is the hallmark of allergic eye disease, which is accompanied by redness and watering of the eyes (fig 1). Symptoms may occur in acute episodes which are generally recurrent or may be persistent in a chronic form.

Fig 1 Seasonal allergic conjunctivitis presenting acutely, with conjunctival redness and swelling (chemosis). Note that the cornea is clear, with no signs of keratitis

What are the different types of allergic eye disease?

Table 1 summarises the different types.

View this table:
Table 1

Clinical presentation and features of allergic eye disease subtypes

Common allergic eye diseases

Seasonal and perennial allergic conjunctivitis are the commonest forms of allergic eye disease and are associated with childhood atopy. Seasonal conjunctivitis is triggered by pollen and frequently occurs in spring and summer. It is often associated with nasal symptoms (rhinoconjunctivitis).

Perennial …

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