Allergic Eye Disease in Adults: Differences in Clinical Profile Based on the Age of Onset

To describe the clinical profile of allergic eye disease (AED) in adults and to compare clinical presentation and course based on the age-of-onset.

This retrospective cross-sectional hospital-based study included 5030 adults (>21 years) presenting with AED to a tertiary eye care center from 2015 to 2022. Based on age of onset, patients were subgrouped as adult-onset (>21 years) or childhood-onset (≤21 years) groups. Data were collected using an electronic medical record system and analyzed appropriately.

Of the 5030 patients (54% males, median age 34 (interquartile range: 27-45) years), 4475 (89%) had adult-onset and 555 (11%) had childhood-onset AED. Although male preponderance was seen in the childhood-onset group, no gender differences were noted in the adult-onset group. Although vernal keratoconjunctivitis was the commonest allergy type in both groups, limbal involvement was greater in the childhood-onset group (45% vs. 16%, P < 0.0001). The most common comorbidities seen were keratoconus (14.05%), limbal stem cell deficiency (7.74%), and steroid-induced glaucoma (SIG; 6.66%) in the childhood-onset and ptosis (2.19%), keratoconus (1.87%), and SIG (1.29%) in the adult-onset group. Early age of onset of allergy was associated with higher risk of complications, with the childhood-onset group showing higher odds of keratoconus, limbal stem cell deficiency, and SIG (odds ratio: 4.5, 6.7, 10.4; P < 0.001) compared with the adult-onset group.

This study explores AED in adults, revealing differences between adult-onset and childhood-onset allergies. Despite similarities in predominant type of allergy, the childhood-onset group showed higher rates of ocular morbidity, underscoring long-term impact of early-onset disease and the need for targeted research and timely age-stratified management.