MANAGEMENT OF ALLERGIC CONJUNCTIVITIS

Allergic conjunctivitis, unlike several other ocular diseases, is very seldom followed by permanent visual impairment; nevertheless its impo rtance is due to both its frequency and its severity. A thorough knowl edge of the pathophysiological aspects and clinical features of allerg ic conjunctivitis allows physicians to choose the best and most suitab le management from the many alternatives. Management varies according to symptom severity and the characteristics of the allergic reaction, generally, it is based on environmental control, pharmacotherapy and, sometimes, specific immunotherapy. Topical vasoconstrictors, decongest ant compounds or classic histamine H-1 antagonists, or combinations of these drugs, have been available for decades to treat the acute and/o r persistent symptomatology, and to prevent the adverse effects of pro longed treatment with topical corticosteroids. Nevertheless, corticost eroids are the most powerful anti-inflammatory drugs, and are particul arly recommended for the short term treatment of severe, acute symptom atology. Orally administered histamine H-1 receptor antagonists are ef fective and convenient for either short or long term treatment, especi ally since the newer second-generation compounds, such as cetirizine, loratadine and terfenadine, act also on the inflammatory process under lying the allergic event. Recently, other topical compounds such as so dium cromoglycate (cromolyn sodium), nedocromil, lodoxamide, spaglumic acid and nonsteroidal anti-inflammatory drugs have been available. So dium cromoglycate, nedocromil, lodoxamide and spaglumic acid exert an antiallergic activity by stabilising the mast cell membrane; nonsteroi dal antiinflammatory drugs represent an effective alternative to corti costeroids in some cases. The aim of this review is a global evaluatio n of the common and up-to-date pharmacologically available protocols i n the treatment of allergic conjunctivitis.