Managing Common Ocular Surface Conditions: Focus on Ocular Allergies

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The latest issue is out and features in-depth articles on conditions affecting the ocular surface, including dry eye, ocular allergies, and keratoconus. While many of these conditions, such as dry eye and allergic conjunctivitis, do not typically result in significant vision loss, they are among the most common reasons patients seek eye care. Even mild cases can cause discomfort and have a substantial impact on patient’s quality of life. If left untreated, these conditions can lead to permanent corneal changes and potential vision impairment. This issue provides practical, up-to-date guidance on managing conditions like dry eye disease, which affects between 5 % to 50% of people and can cause constant irritation and ocular allergies, often leading to intense itching and inflammation. Children and some adults suffer significantly, with symptoms sometimes causing social withdrawal or missed school days. The issue also covers keratoconus, a progressive thinning of the cornea that can result from chronic eye rubbing and untreated allergic eye disease, highlighting treatments such as corneal cross-linking.

About This Flyer: A Quick Guide for Managing Ocular Allergies

This flyer serves as a quick reference guide for health workers on managing ocular allergies, offering practical tips to educate patients, prevent complications, and ensure proper care. It emphasises the importance of follow-up care, especially in chronic cases, to protect against long-term issues such as keratoconus and vision loss. Turn the page for a detailed guide on managing ocular allergies effectively!

Ocular allergy is a broad term encompassing different types of allergic inflammation of the conjunctiva and/or cornea in response to allergens and irritants in a patient’s environment. They often present with itchy, red, watery eyes and can be seasonal or perennial. Ocular allergy is more common in hot, dry and dusty regions. It can particularly affect children and young people, causing social withdrawal and loss of schooling. Eye rubbing due to allergies can lead to keratoconus, so controlling the condition is important to prevent long-term complications such as vision loss.

Symptoms and Signs

Mild Ocular Allergy (Affects only the conjunctiva):

• Itching

• Watering

• Redness

• Mild conjunctival swelling (blister-like)

• Sensitivity to light

Severe Ocular Allergy (Corneal involvement):

• Large cobblestone-like papillae inside the eyelids

• Swelling at the corneal edge (with white nodules)

• Risk of shield ulcers from bumps inside the eyelids damaging the cornea

Diagnosis Tips

• History: Ask about allergen exposure, seasonal patterns, and family allergy history.

• Examination: Check for redness, swelling, and watery eyes.

• Differentiation from Other Conditions:

– No vision loss or pain (signs of more serious conditions)

– Clear discharge vs. thick, colored discharge (infection)

– Dry eye syndrome typically lacks itching

Management & Treatment

Non-Pharmacological Measures

• Avoid known allergens

• Cold compresses to reduce swelling and itching

• Artificial tears to flush allergens from the eyes

Pharmacological Treatment

• Antihistamine eye drops: Relieve itching and redness

• Oral antihistamines: Manage systemic allergies

• Mast cell stabilisers or steroid drops for severe cases

Red Flags for Referral

Non-Pharmacological Measures

• Severe pain or sudden vision loss

• No improvement with over-the-counter treatments

• Thick, colored discharge indicating infection

• History of systemic allergic conditions (e.g., asthma, dermatitis)

Important Advice

• Discourage eye rubbing to prevent keratoconus and vision loss.

• Inform patients that chronic or untreated allergies can lead to serious complications.

Follow-Up Care

Encourage consistent follow-ups for chronic cases to ensure proper care and prevent complications.