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Purpose of Review: The purpose of the present review is to provide an overview on the clinical features and long-term complications of severe ocular allergies, with a special focus on the corneal involvement observed in these diseases, which may impair vision permanently. Furthermore, different treatment options are discussed based on the sight-threatening effects of corticosteroid use., Recent Findings: Recent data on the demographics, clinical and immunologic features of vernal and atopic keratoconjunctivitis are presented and discussed, and the evidence of a lack of literature addressing the issue of visual outcome in allergic diseases is underlined. The efficacy and possible long-term complications of their treatments are described, including visual impairment., Summary: Diagnosis and treatment of patients with severe ocular allergy is a challenge for ophthalmologists due to the long-term corneal complications and the potential side-effects of topical corticosteroids that may induce cataract formation and glaucoma, and impair vision permanently. The review describes old and new concepts of management and possible complications such as severe, vision-threatening forms of allergic ocular disease. An update on their management and long-term complications may help clinicians to establish a common agreement on treatment options and researchers to design future studies based on similar outcomes, including visual acuity.