Allergic eye disease in clinical practice: essential updates for eye care professionals

Allergic eye disease affects 15-40% of people worldwide, particularly children and adolescents, and often coexists with atopic dermatitis, allergic asthma, and allergic rhinitis. To capture the latest insights into its causes, presentation and management, the authors performed a comprehensive PubMed/MEDLINE literature review through April 2025 using multiple search terms such as 'ocular allergy', 'allergic conjunctivitis', 'Seasonal Allergic Conjunctivitis', 'Perennial Allergic Conjunctivitis', 'Atopic Keratoconjunctivitis', 'Giant Papillary Conjunctivitis', "Contact Blepharoconjunctivitis, 'Vernal Keratoconjunctivitis', 'Shield Ulcers', 'immunology', 'allergic rhinitis', and related terminologies. The current review review integrates epidemiological data, mechanistic studies and clinical guidelines to offer a cohesive overview of this condition. Allergic eye disease arises when environmental allergens trigger an IgE-mediated immune response in the eye, leading to inflammation that ranges from mild seasonal redness and itching to severe forms with tissue changes and corneal involvement. Diagnosis depends on the history and eye examination of a patient, with ancillary tests used only when the presentation is unclear. Management begins with allergen avoidance, lubricating drops and cold compresses, progressing to topical antihistamines or mast-cell stabilisers and short-course corticosteroids for flares. Looking ahead, newer treatments such as calcineurin inhibitors, monoclonal antibodies against key inflammatory cytokines and targeted small-molecule drugs are expanding the ability to control symptoms without long-term steroid use. Given its chronic, relapsing nature and potential to cause ocular surface damage, corneal complications, and visual morbidity, early recognition and stage-appropriate management of allergic eye disease are essential in routine clinical practice to preserve ocular surface integrity, maintain visual function, and improve patient quality of life.