Corneal disease is the primary cause of visual loss in allergic eye disease

Corneal disease is the primary cause of visual loss in allergic eye disease. It occurs almost exclusively in vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC).


Classification of ocular allergy (click to enlarge the image).

Vernal keratoconjunctivitis is a relatively rare ocular allergic disease affecting children and young adults living in warm climates. In 50% of cases, it is associated with other allergic diseases. Cyclosporine eye drops prevent seasonal recurrences of vernal keratoconjunctivitis in a 2-year study (JACI, 2011). See Vernal Keratoconjunctivitis - NEJM images, 2012.

By contrast, AKC typically presents later in life, occurring in 20–40% of patients with atopic dermatitis.

Corneal disease currently requires aggressive treatment with topical steroids.

Clinicians should also be aware of steroid resistance and dependency. In these cases, new, off-label treatments can be considered.

Topical cyclosporin (CsA) has the longest history of clinically proved efficacy in controlling the signs and symptoms of severe allergy.



Ocular antihistamines (eye drops) (click to enlarge the image).

References:

Mechanisms of Corneal Allergic Reaction: New Options for Treatment. Medscape.
Ocular Allergy: Allergic Conjunctivitis and Related Conditions, Brief Review
Cyclosporine eye drops work as steroid sparing therapy in vernal keratoconjunctivitis http://goo.gl/GTNyS and http://goo.gl/Vi82k
NEJM - Image Challenge http://buff.ly/1nts5dD
Eye Drops for allergic conjunctivitis - why would AAAAI include a homeopathic medications in this list? http://buff.ly/1kPCOgn