With the increasing incidence of atopy, the treatment of allergic eye disease has gained in importance in recent years. Treatments are designed to interfere with either the type 1 (immunoglobulin E [IgE]-mediated) or type 4 (delayed) hypersensitivity response, both of which are thought to be important in disease pathogenesis. For mild disease, initial treatment should involve antigen avoidance (if known) and frequent use of artificial tears (hypromel-lose) to wash away antigens from the ocular and conjunctival surface. Treatment of more severe disease involves the use of systemic or topical antihistamines (levocabastine, emedastine and azelastine), which are helpful for relief of symp toms, and topical mast cell stabilisers (sodium cromoglicate, nedocromil sodium and lodox-amide), which are useful in disease prevention if used regularly. The treatment of severe (sight-threatening) disease involves the use of courses of topical and occasionally oral steroids.
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