Ocular Allergy: Clinical Phenotypes, Immunopathogenesis, and Current Therapeutic Strategies

Ocular allergy comprises a range of inflammatory conditions affecting the ocular surface, with allergic conjunctivitis (AC) representing a common clinical manifestation. Despite the availability of several therapeutic options, effective long-term management remains challenging because of the heterogeneous clinical presentation and complex underlying mechanisms of the disease. This narrative review summarizes the etiology, clinical manifestations, immunopathogenesis, and current and emerging therapeutic strategies for AC, emphasizing their clinical relevance and implications for disease management. Mild disease is generally managed with allergen avoidance, supportive measures, and topical antihistamines or dual-action agents, whereas severe or persistent disease may require topical corticosteroids or immunomodulators, depending on the phenotype and severity. Allergen-specific immunotherapy (AIT) may provide longer-term disease modification in selected patients. Emerging therapies, including biologics and targeted small-molecule inhibitors, offer additional treatment possibilities; however, clinical evidence for most remains limited, and further studies are needed to establish their efficacy, safety, and appropriate use. Important challenges include disease heterogeneity, limited availability of validated biomarkers, and difficulties translating experimental findings into clinical practice. Ultimately, treatment tailored to disease phenotype and severity, based on the underlying inflammatory mechanisms, can improve long-term disease control and ocular-surface outcomes. Continued research into the biological complexity of AC is essential for developing safer and more effective treatments that improve ocular health and quality of life.