Background Information

Clinical Features

Hallmark of allergic conjunctivitis: bilateral ocular itching (may also be described as burning or stinging).

Other clinical features:

• Watery or mucoid discharge
• Hyperaemia injection (conjunctival redness)
• Chemosis (conjunctival swelling)
• Eyelid oedema

Allergic conjunctivitis often co-exists with other atopic conditions, the atopic triad:

• Atopic dermatitis (eczema)
• Asthma
• Allergic rhinitis

Guidelines

Investigation and Diagnosis

First, exclude red flags of a red eye warranting referral. See Red Eye Referral

Allergic conjunctivitis is a clinical diagnosis​​​​​, investigations are not normally required.

Management

General Management / Conservative Management

Advise the patient on:

• Allergen avoidance
• Avoid rubbing the eyes

Symptomatic management measures:

• Application of cold compresses to the eyes
• Application of ocular surface lubricants (e.g. artificial tears and saline solution)

Pharmacological Management

1st line:

• Topical antihistamine (e.g. anatazoline, also contains xylometazoline), or

• Dual action mast cell stabiliser / topical antihistamine (e.g. azelastine, epinastine, ketotifen, olopatadine)
  • Examples of mast cell stabilisers: sodium cromoglicate, lodoxamide

2nd line:

• Consider adding topical ocular dicofenac

References

Original Guideline