From the Guidelines
For allergy eye drops, I recommend using dual-action agents such as olopatadine (Pataday) or ketotifen (Alaway, Zaditor) as first-line treatments, as they have been shown to be effective in preventing or treating ocular itching and have a rapid onset of action within 30 minutes 1. These medications work by blocking histamine receptors and stabilizing mast cells, reducing itching, redness, and tearing caused by allergic reactions. Some key points to consider when using allergy eye drops include:
- Using 1-2 drops in each affected eye up to twice daily as directed on the package
- Avoiding redness-reducing drops like Visine as regular use can lead to rebound redness
- Always washing hands before application, not touching the tip to any surface, and waiting at least 5 minutes between different eye medications if using multiple types
- Removing contact lenses before using drops and waiting 10-15 minutes before reinserting
- Consulting an eye care professional if symptoms persist beyond 72 hours or worsen, as you may need different treatment. It's also important to note that oral antihistamines are generally less effective in relieving ocular allergy symptoms than topical ophthalmic agents and have slower onset of action, and may also be associated with excessive drying of the tear film 1. In terms of specific medications, some options include:
- Olopatadine (Pataday, Patanol)
- Ketotifen (Alaway, Zaditor)
- Azelastine (Optivar)
- Epinastine (Elestat) These medications have been shown to be effective in clinical trials and have a favorable safety profile 1.
From the FDA Drug Label
Loteprednol Etabonate Ophthalmic Suspension, 0.2% is indicated for the temporary relief of the signs and symptoms of seasonal allergic conjunctivitis. In two double-masked, placebo-controlled six-week environmental studies of 268 patients with seasonal allergic conjunctivitis, Loteprednol Etabonate Ophthalmic Suspension, 0. 2%, when dosed four times per day was superior to placebo in the treatment of the signs and symptoms of seasonal allergic conjunctivitis.
Allergy Eye Drops: Loteprednol etabonate ophthalmic suspension, 0.2% is used for the temporary relief of the signs and symptoms of seasonal allergic conjunctivitis.
- It provides 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 2.
- The recommended dosage is four times per day 2.
- It is indicated for the temporary relief of the signs and symptoms of seasonal allergic conjunctivitis 2.
From the Research
Allergy Eye Drops
- Allergy eye drops are used to treat ocular allergies, with seasonal and perennial allergic conjunctivitis (SAC and PAC) being the most frequent causes of ocular allergy 3.
- These conditions are often underdiagnosed and undertreated, and can be managed with topical therapy using antihistamines, mast cell stabilizers, or dual-action agents as first-line treatment 3, 4.
- Dual-action agents, such as olopatadine, azelastine, and epinastine, are commonly used to treat mild forms of allergic conjunctivitis and have been shown to be effective in reducing symptoms such as ocular itch and conjunctival hyperemia 4.
- Newer formulations of topical dual-action agents have longer durations of action, leading to decreased frequencies of use, and high-concentration olopatadine has been shown to be superior to other agents in treating ocular itch 4.
- Other options for treating ocular allergies include reformulated antihistamines, such as cetrizine, and newer drugs and drug-delivery systems, such as immunotherapy and steroids 5.
Mechanism of Action
- Antihistamines, such as cetirizine, work by blocking the action of histamine, a chemical released by mast cells during an allergic reaction, and have also been shown to have mast cell-stabilizing properties 6, 7.
- Mast cell stabilizers, such as cromolyn sodium, work by preventing the release of histamine and other chemical mediators from mast cells, thereby reducing inflammation and symptoms 6.
- Dual-action agents combine the properties of antihistamines and mast cell stabilizers, providing both immediate relief from symptoms and long-term prevention of inflammation 4.
Treatment Options
- Topical antihistamines, such as alcaftadine and levocabastine, are effective in treating symptoms of allergic conjunctivitis, including ocular itch and conjunctival hyperemia 4.
- Mast cell stabilizers, such as ketotifen and epinastine, are also effective in treating allergic conjunctivitis and can be used in combination with antihistamines for added benefit 4.
- Dual-action agents, such as olopatadine and azelastine, are commonly used to treat mild forms of allergic conjunctivitis and have been shown to be effective in reducing symptoms and improving quality of life 4, 5.