From the Guidelines
To treat itchy eyes, the most effective approach is to use dual-action agents that possess both antihistamine and mast cell stabilizer activities, such as Azelastine (Optivar) or Olopatadine (Pataday, Patanol), as they have a rapid onset of action and are suitable for acute and longer-term treatment of allergic conjunctivitis symptoms. These agents have been shown to be more effective in preventing or treating ocular itching than other ocular agents, including vasoconstrictors, antihistamines, and mast cell stabilizers alone 1.
When selecting a treatment, it is essential to consider the potential side effects and risks associated with each option. Vasoconstrictors, for example, can lead to rebound hyperemia or conjunctivitis medicamentosa with prolonged use, although limited use of up to 10 days appears to be safe 1. Antihistamines can provide relief, but their effectiveness may be enhanced when combined with a vasoconstrictor 1. Mast cell stabilizers have a slower onset of action and are more suitable for prophylactic or longer-term treatment, while topical NSAIDs like Ketorolac can reduce prostaglandin production involved in mediating ocular allergy 1.
In addition to topical treatments, avoiding triggers such as pollen, pet dander, or certain cosmetics can help prevent recurrences. Cold compresses applied to closed eyes for 5-10 minutes can provide immediate relief by reducing inflammation and constricting blood vessels. It is also crucial to avoid rubbing the eyes, as this can release more histamine and worsen itching. If symptoms persist beyond a week, worsen, or are accompanied by pain, discharge, or vision changes, consulting an eye care professional is necessary, as prescription-strength medications may be required or there could be an underlying condition needing specific treatment.
Key considerations for treatment include:
- Using dual-action agents for their rapid onset and effectiveness in treating allergic conjunctivitis symptoms
- Avoiding prolonged use of vasoconstrictors to prevent rebound hyperemia or conjunctivitis medicamentosa
- Considering the potential benefits and risks of antihistamines, mast cell stabilizers, and topical NSAIDs
- Identifying and avoiding triggers to prevent recurrences
- Seeking professional help if symptoms persist or worsen, indicating potential underlying conditions requiring specific treatment 1.
From the FDA Drug Label
Loteprednol Etabonate Ophthalmic Suspension, 0.2% provided reduction in bulbar conjunctival injection and itching, beginning approximately 2 hours after instillation of the first dose and throughout the first 14 days of treatment. Uses temporarily relieves itchy and red eyes due to pollen, ragweed, grass, animal hair and dander Use Temporarily relieves itchy eyes due to pollen, ragweed, grass, animal hair and dander.
Itchy eye treatment options include:
- Loteprednol etabonate (OPHTH) 2, which reduces itching and bulbar conjunctival injection
- Olopatadine (OPHTH) 3, which temporarily relieves itchy and red eyes
- Ketotifen (OPHTH) 4, which temporarily relieves itchy eyes These medications can be used to treat itchy eyes caused by allergies, such as those triggered by pollen, ragweed, grass, animal hair, and dander.
From the Research
Itchy Eye Treatment Options
Itchy eyes can be a symptom of various conditions, including allergic conjunctivitis. Several studies have compared the efficacy of different eye drops in treating itchy eyes, including:
Comparison of Olopatadine and Ketotifen
Studies have shown that both olopatadine and ketotifen are effective in treating itchy eyes, but some differences have been observed:
- A study published in 2004 found that 81% of patients preferred olopatadine over ketotifen due to its efficacy and comfort 5
- A study published in 2009 found that olopatadine was more effective than ketotifen in improving itching, tearing, and burning in patients with allergic conjunctivitis 6
- A study published in 2005 found that both ketotifen and olopatadine diminished the expression of cell adhesion molecules and inflammatory markers on the conjunctival surface cells, but no significant difference was found between the two treatments 7
- A study published in 2003 found that ketotifen had a higher responder rate and global efficacy ratings compared to olopatadine, but both drugs had comparable comfort ratings 8
- A study published in 2014 found that preservative-free ketotifen and preserved olopatadine had similar efficacy in treating moderate to severe seasonal allergic conjunctivitis, but ketotifen had a trend for better tolerability 9
Key Findings
Some key findings from the studies include:
- Olopatadine and ketotifen are both effective in treating itchy eyes, but may have different efficacy profiles 5, 6, 7, 8, 9
- Patient preference and comfort may play a role in determining the most effective treatment 5, 8
- The expression of cell adhesion molecules and inflammatory markers on the conjunctival surface cells may be reduced with both ketotifen and olopatadine treatment 7
- Preservative-free ketotifen may have a trend for better tolerability compared to preserved olopatadine 9