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Allergic eye disease

The following information provides a guide for GPs on how to manage or make a referral for presentation of Allergic eye disease (seasonal, perennial, vernal, atopic) in children.

 

  • Low risk pathology

    • No previous eye clinic diagnosis of allergic eye disease AND mild to moderate symptoms (itching, redness, watering) 
    • Mild to moderate flare-up of known vernal or atopic keratoconjunctivitis – exception: no improvement after two weeks of GP-prescribed treatment   

     

    Do not refer (See GP management & self care below)

  • Potential serious pathology

    • Severe symptoms and marked redness and pain, or any involvement of the cornea in any situation
    • No previous eye clinic diagnosis of allergic eye disease AND no improvement after one month of GP prescribed treatment
    • Previous diagnosis of vernal or atopic keratoconjunctivitis AND no improvement after two weeks of GP treatment
    • No previous eye clinic diagnosis of allergic eye disease AND no improvement after one month of G olopatadine or G ketotifen twice daily
    • Previous diagnosis of vernal or atopic keratoconjunctivitis AND no improvement after one month of combination treatment with
      • G olopatadine or G ketotifen twice daily plus
      • G ciclosporine A 1mg/ml four times a day 

     

    Urgent referral to Acute Eye Clinic

GP Management

Olopatidine 1mg/ml (Opatanol) twice daily throughout pollen season +/- rest of year as maintenance whilst condition persists [Lodoxamide two to four times daily and Sodium Cromoglycate 2% four times daily are alternatives but less effective/more frequent use needed)

If previously prescribed by hospital, for vernal/atopic: G ciclosporin A 1mg/ml (Verkazia, licensed in children) four times a day initially and twice to four times daily for maintenance.

Long term: can try to reduce and stop during the winter months

Carbomer or sodium hyaluronate (artificial tears) as necessary up to four times a day can provide a degree of extra symptom relief for mild disease

For associated blepharitis: Please add treatment from blepharitis pathway.

Treat associated lid eczema with emollients +/- short course 1% hydrocortisone skin cream/ointment.

 

Self-care & advice

  • Cold compresses
  • Over-the-counter anti-histamine eyedrops in mild disease (but no point if using opatanol)
  • Reduce exposure (wear sunglasses, sunhat)
  • If runny nose as well as itchy eyes: oral antihistamines, nasal sprays
  • If lid eczema: emollient cream
  • If blepharitis: warm lid compresses and lid margin cleaning
  • Children usually get better / condition disappears once older but may recur and need treatment especially during spring / summer for some years

 

Referral information

Always include:

  • Child’s date of birth
  • Address
  • Child’s social worker details (including Borough), if any
  • Parent/carer contact phone number and email

 

Further Assistance

This pathway has been produced by the Moorfields hospital to help clinicians manage the healthcare of Children and Young People. However, if you need to contact a Paediatric clinician, please see below for contact details:

Moorfields Eye Hospital:

Paediatric helpline: 0207 2533411 extn 4569, Mon- Fri 10:00am-13:00pm then 14:00pm-16:00pm

 

Last update: April 2021