Allergic conjunctivitis therapy reference (2026)

Allergic conjunctivitis therapy in 2026 organises around several tiers based on severity and chronicity.

Mild and seasonal: topical antihistamines, mast cell stabilisers, and combined antihistamine plus mast cell stabiliser eye drops (olopatadine, ketotifen, alcaftadine, bepotastine, cetirizine ophthalmic, others). Cool compresses, allergen avoidance, artificial tears for symptom relief.

Persistent or moderate: combined topical agents, oral antihistamines as adjunct. Topical NSAIDs (ketorolac) for selected cases. Topical low-potency corticosteroids for short courses in flare.

Severe or chronic (vernal keratoconjunctivitis, atopic keratoconjunctivitis): topical cyclosporine, topical tacrolimus (off-label), systemic immunosuppression in selected cases, topical corticosteroids carefully managed for eye-related risks (cataract, intraocular pressure elevation).

Biologic therapy: dupilumab is used (off-label for severe vernal or atopic keratoconjunctivitis associated with broader atopic disease) given the cross-cluster type-2 inflammation mechanism. Some patients on dupilumab for atopic dermatitis or asthma develop conjunctivitis as a side effect; this is a separate clinical issue.

Emerging: TRPM8 pathway and other novel mechanism topical programs, additional biologic-pathway approaches in late-stage trials.

The diagnostic-and-care-pathway question matters. Distinguishing allergic conjunctivitis from other causes (dry eye, infectious conjunctivitis, blepharitis, contact lens-related issues), identifying contributing systemic atopy, and integrating with allergy-immunology care all shape modern care.