Allergic Conjunctivitis

NICE CKS Conjunctivitis - allergic. Last revised: May 2022.

Background Information

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

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.

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)

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

Author: Adams Lau
Reviewer:
Last edited: 28/05/25