Abstract
Background: Currently, the management of Ocular Allergy (OA) in Kenya is not standardised. The
development and implementation of Standard Treatment Guidelines (STGs) is a necessary task in a health
care system where numerous treatments may be available.
Objectives: To describe the approach to management of ocular allergy in Kenya.
Methods: The study was a descriptive (Knowledge, Attitude and Practice) cross-sectional study carried out
among practising ophthalmologists in Kenya from 1st December 2012 to 31st May 2013. Data was collected
using self-administered questionnaires and qualitative methods including focus group discussions and
key informant interviews were used for triangulation and to get detailed information on the attitudes and
practices of the ophthalmologists regarding OA.
Results: A total of 58 ophthalmologists were included in the study (69% response rate). All the participants
reported diagnosing OA based on clinical findings. The majority, >70%, of the ophthalmologists
considered symptom severity, availability of drugs, and treatment tolerability as important factors in
treatment selection. Topical antihistamines and mast cell stabilisers were used by 62% and 57% of the
ophthalmologists respectively as the first line treatment. Majority of the participants indicated the use of
topical immunomodulators/systemic steroids (75.9%) and periocular steroids (72.4%) only for severe cases
though during the discussions, the use of topical immunomodulators and systemic corticosteroids was
not mentioned. The rational use of topical steroids was advised by all the discussion participants so as to
avoid their overuse. Non-pharmacological treatment including allergen avoidance, cold compresses, and
artificial tears were mentioned as being important for providing short-term relief for allergy symptoms.
The use of tear supplements in all grades of severity to provide ocular lubrication and also for dilution of
allergens was mentioned by the majority of the participants in the discussions. Surgical intervention was
suggested only in the management of complications of OA or conditions associated with OA. There is no
national standard treatment guideline for the management of OA. Counselling was seen to form a major
part of the management of a patient with OA though it is inadequate in our setting.
Conclusions: There is no standard treatment guideline followed in the management of ocular allergy. There
is a need to come up with a national guideline so as to harmonise the diagnosis, grading and treatment of
ocular allergy. Patient counselling needs to be emphasized so as to improve compliance to treatment and
follow up appointments.
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