Table 3.

Summary of the practical management of VKC

Make an accurate diagnosis

Educate on avoidance of the offending allergens and nonspecific triggers (use sunglasses, hats with visors, and swimming goggles)

Stress the importance of non-pharmacologic treatments (lubricants, lid hygiene, cold compresses)

Two or more topical, complementary drugs must be used in combination (mast cell stabilizers + antihistamines or multiple action components)

Recommend an adequate frequency of instillation of topical drugs (4–6 times per day)

Warn against use and abuse of decongestant/vasoconstrictors

Recommend systemic antihistamines to reduce hyper-reactivity

Use topical corticosteroid formulations as pulsed therapy (3–5 days) to reduce flare-ups

Corticosteroids must be used in case of moderate to severe corneal epitheliopathy and ulcers

Avoid the continuous use and/or abuse of steroids

Avoid corticosteroids as first-line treatment of VKC

Topical CsA can be considered in moderate to severe VKC and can be steroid-sparing

Removal of corneal plaques is the only surgical procedure recommended in cases of corneal complications

Specific immune therapy is indicated only if extra-allergic manifestations are also present, when a specific offending allergen is clearly identified and clinically related to ocular manifestations