This guideline last updated 06/05/2022 17:48:26

Differential diagnosis

• Vernal Keratoconjunctivitis
• Seasonal Allergic conjunctivitis
• Giant Papillary Conjunctivitis (GPC) (often contact lens-related)
• Toxic Keratoconjunctivitis

Possible management by Optometrist

Treatment

• Lid hygiene and treatment of any associated staphylococcal blepharitis
• Cool compresses
• For acute relief consider PoM topical antihistamine
  • PoM Olopatadine 1 drop twice daily (8 hourly interval) whilst symptomatic
    • Contraindicated in
      • breastfeeding/pregnancy
      • women of childbearing age not using contraception
      • Caution in dry eye/compromised ocular surface if prolonged use planned
    • Refer to local Pharmacist for oral antihistamine
• If persistent, consider use of sodium cromoglicate 2% eye drops 4 times daily

Advice

• Avoid patient identified allergens e.g. elimination of pets and carpeting, where necessary; instillation of air filtering devices and alterations to bedding materials

Management Category

• Urgent referral (within one week) if corneal involvement
• Routine referral for PoM for Milder cases

Possible management by Ophthalmologist

• Topical steroids
• Topical/systemic antibiotic for lids
• Topical immunosuppression for eye and or lids
• Systemic immunosuppression
• Debridement/superficial lamellar keratectomy for corneal plaque/shield ulcer