If your patients suffer from allergic conjunctivitis but don’t respond well to local treatment, it might be worth checking to see if they have allergic rhinitis, say Dutch researchers. The study aimed to investigate the role of nasal allergy in seasonal and perennial allergic conjunctivitis, and involved 61 adult patients with allergic conjunctivitis who responded poorly to local treatment. The patients were subjected to nasal challenges with allergens, and the nasal and ocular responses measured. A significant number developed a conjunctival response as well as a nasal reaction to the allergens. The authors comment that there may be two types of allergic conjunctivitis: a primary form with the initial reaction in the conjunctiva, and a secondary type induced by an allergic reaction occurring initially in the nasal mucosa, but with clinical symptoms displayed in the conjunctiva. They suggest performing nasal provocation tests in combination with monitoring the cornea in patients who appear refractory to conventional ophthalmological treatment.