What is your approach for treating allergic conjunctivitis in a patient who has failed ketotifen and olopatadine?

Agree with Dr. @Dr. First Last - and for in-office treatments, I've been increasingly impressed with Rinsada irrigation in some cases (rinse out the fornix, which seems to trap some allergens there), as well as mitigation and desensitization therapy if the allergist can find specific allergens to focus on. Also, treating any underlying dry eye disease (as a dry eye is an unhappy one that will generally react more substantially to any insults - allergy or otherwise). Demodex not only appears to c...

While still young in my career, I have found the following helpful as part of my treatment algorithm.

1. For all patients: avoid touching and rubbing eyes, and use cold compresses. If known/avoidable allergens, try to find ways to avoid (similar to the above threads).
2. Start with cold compresses + topical antihistamine/mast cell stabilizers +/- oral second-generation antihistamines.
3. I often will try (for those without glaucoma or known steroid response) a short course of low-potency steroids (FML, ...

1. Morning, night, and when symptomatic, wash hands thoroughly, splash cold water in and around eyes to dislodge pollens and danders. Ice water compress if chemosis.
2. 1 oral ibuprofen q.a.m.
3. Consider oral montelukast 10 mg per day during symptomatic periods.
4. Remove known allergens from the environment.
5. Change pillowcase nightly.
6. Change bedsheets often.
7. Don't sleep with pets.
8. Go dairy-free for 1 month to see if that helps.
   1. Look for dairy protein (casein) in medications as a binder.
9. Go gluten-free...