The treatment and management of ocular allergy (OA) remains a major concern for different specialties, including allergists, ophthalmologists, primary care physicians, rhinologists, pediatricians, dermatologists, clinical immunologists and pharmacists. We performed a systematic review of all relevant publications in Medline, SCOPUS and WebScience including systematic reviews and meta-analysis. Publications were considered relevant if they addressed treatments, or management strategies of OA. A further wider systematic literature search was performed if no evidence or good quality evidence was found. There are effective drugs for the treatment of OA, however there is a lack an optimal treatment for the perennial and severe forms. Topical antihistamines, mast cell stabilizers or double action drugs are the first choice of treatment. All of them are effective in reducing signs and symptoms of OA. The safety and optimal dosing regimen of the most effective topical anti-inflammatory drugs, corticosteroids, is still a major concern. Topical calcineurine inhibitors may be used in steroid-dependent/resistant cases of severe allergic keratoconjunctivitis. Allergen specific immunotherapy may be considered in cases of failure of first line treatments or to modify the natural course of OA disease. Based on the current wealth of publications and on the collective experience, recommendations on management of OA have been proposed. This article is protected by copyright. All rights reserved.