What are the first-line treatment options for allergic conjunctivitis in adults and children?

First-line treatment options for allergic conjunctivitis in both adults and children primarily include the use of topical antihistamines and mast cell stabilisers. These agents help to alleviate symptoms such as itching, redness, and swelling by blocking histamine receptors and preventing mast cell degranulation, respectively ¹.

In clinical practice, topical antihistamines such as olopatadine or ketotifen are commonly recommended due to their rapid onset of action and dual antihistamine and mast cell stabilising properties, making them effective for immediate symptom relief and prevention ¹.

For children, these treatments are generally considered safe and effective, with formulations available that are suitable for paediatric use ¹.

Adjunctive measures include the use of artificial tears to dilute allergens and soothe the ocular surface, and cold compresses to reduce inflammation and discomfort ¹.

In cases where symptoms are more severe or persistent, short courses of topical corticosteroids may be considered but are not first-line due to potential side effects; this approach is reserved for specialist management ¹.

Recent literature supports these recommendations, highlighting the efficacy and safety of topical antihistamines and mast cell stabilisers as first-line agents in both adults and children, with ongoing updates on newer ophthalmic solutions that combine these mechanisms for improved patient adherence and outcomes (Leonardi et al., 2024; Miyazaki et al., 2020).