What are the treatment options for allergic conjunctivitis using eye drops?

From the Guidelines

For allergic conjunctivitis, I strongly recommend using over-the-counter antihistamine eye drops like ketotifen (Zaditor, Alaway) or olopatadine (Pataday) as the first line of treatment. These drops work quickly to relieve itching, redness, and watery eyes caused by allergies, and are safe for most people to use daily during allergy season 1. The antihistamine in these drops blocks the histamine that causes allergy symptoms in your eyes.

Key Points to Consider

• Use 1-2 drops in each affected eye twice daily or as directed on the package
• Wash your hands before use
• Don't touch the dropper tip to your eye or any surface
• Wait at least 10 minutes between different eye medications
• Store at room temperature and replace after 3 months of opening

Additional Recommendations

• For mild allergic conjunctivitis, over-the-counter topical antihistamine/vasoconstrictor agents or second-generation topical histamine H1-receptor antagonists can be used 1
• For chronic use, mast-cell stabilizers can be used to alleviate symptoms 1
• Topical mast-cell inhibitors can also be helpful in alleviating symptoms of allergic rhinitis 1

Important Considerations

• If symptoms persist or worsen after a week of use, consult an eye doctor for further evaluation and potential prescription-strength drops 1
• Reducing exposure to allergens and using air filters can help prevent symptoms in the first place 1

From the FDA Drug Label

CLINICAL PHARMACOLOGY Corticosteroids inhibit the inflammatory response to a variety of inciting agents and probably delay or slow healing. Clinical Studies: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. Directions Adults and children 3 years of age and older: Put 1 drop in the affected eye(s) twice daily, every 8-12 hours, no more than twice per day. Directions adults and children 2 years of age and older: put 1 drop in the affected eye(s) once daily, no more than once per day if using other ophthalmic products while using this product, wait at least 5 minutes between each product

The treatment options for allergic conjunctivitis using eye drops are:

• Loteprednol etabonate (2): 0.2% suspension, dosed four times per day
• Ketotifen (3): 1 drop in the affected eye(s) twice daily, every 8-12 hours
• Olopatadine (4): 1 drop in the affected eye(s) once daily Key considerations:
• Dosage and administration may vary depending on the specific product and patient population
• It is essential to follow the recommended dosage and administration instructions for each product to ensure safe and effective treatment.

From the Research

Treatment Options for Allergic Conjunctivitis

The treatment options for allergic conjunctivitis using eye drops include:

• Antihistamines, such as olopatadine 0.1% 5, alcaftadine, levocabastine, and azelastine 6
• Mast cell stabilizers, such as ketotifen 0.025% 5, 7
• Dual-action agents, such as olopatadine, azelastine, ketotifen, and epinastine, which combine antihistamine and mast cell stabilizing properties 6
• Topical corticosteroids, which may be used for moderate-to-severe cases 8

Efficacy of Treatment Options

Studies have shown that:

• Olopatadine 0.1% is more effective than ketotifen 0.025% in reducing symptoms of allergic conjunctivitis 5
• High-concentration olopatadine 0.77% has a longer duration of action and better efficacy on ocular itch compared to low-concentration olopatadine 0.2% 6
• Epinastine 0.05% is superior to placebo and equal or more effective than olopatadine 0.1% in treating symptoms of allergic conjunctivitis 6
• Ketotifen fumarate 0.025% has a higher responder rate and better global efficacy ratings compared to olopatadine hydrochloride 0.1% in some studies 7

Safety and Comfort of Treatment Options

Studies have shown that:

• Olopatadine and ketotifen have comparable comfort ratings 5, 7
• The most common adverse events associated with these medications are burning/stinging and headache 7
• Olopatadine hydrochloride eye drops have been shown to provide quick relief of symptoms and signs of allergic conjunctivitis, with a systematic review aiming to evaluate their effectiveness and safety 9