Ranking the efficacy of topical treatments for ocular allergy: A network meta-analysis of current evidence.

PURPOSE: To evaluate and rank the comparative effectiveness of topical treatments for different types of ocular allergies through a systematic review and network meta-analysis.

METHODS

A systematic search of electronic databases identified between January 2000 and December 2024 from PubMed, Cochrane CENTRAL, Google Scholar, and Scopus databases. Study Selection; randomized controlled trials assessing topical treatments for ocular allergy, including antihistamines, corticosteroids, immunomodulators, and combination therapies. Data Extraction and Synthesis; data were independently extracted and analyzed following PRISMA guidelines. Direct and indirect comparisons were evaluated using network meta-analysis, and SUCRA rankings assessed relative efficacy. Main Outcomes and Measures; reduction in ocular itching, redness, and inflammation. PROSPERO Registration number: CRD42025634572.

RESULTS

Olopatadine 0.1 % demonstrated highest efficacy in seasonal and perennial allergic conjunctivitis (SUCRA 0.88 and 0.85, respectively), while Tacrolimus 0.1 % showed superior effectiveness in vernal and atopic keratoconjunctivitis (SUCRA 0.92 and 0.89, respectively). Overall treatment effect was significant (OR = 6.95, 95 % CI: 6.24-7.75) with moderate heterogeneity (I2 = 50.8 %). Subgroup analysis revealed consistent efficacy across different types of allergic conjunctivitis, with seasonal allergic conjunctivitis showing the highest cumulative ranking probability (89.0 %).

CONCLUSIONS

This network meta-analysis provides strong evidence supporting condition-specific treatment approaches in ocular allergies. Newer antihistamines, particularly Olopatadine, are most effective for mild-moderate conditions, while immunomodulators, especially Tacrolimus, show superior efficacy in severe cases. These findings provide clear evidence-based hierarchies for clinical decision-making in the management of different types of allergic conjunctivitis.