What are the recommended eye drops for allergic eye conditions?

From the Guidelines

For allergic eye conditions, dual-action antihistamine and mast cell stabilizer eye drops, such as ketotifen (Alaway, Zaditor), olopatadine (Pataday, Patanol), or azelastine (Optivar), are the most effective and recommended first-line treatments. These medications work by blocking histamine receptors and stabilizing mast cells to reduce itching, redness, and tearing, with an onset of action within 30 minutes 1. They are suitable for both acute and longer-term treatment of allergic conjunctivitis symptoms. Most are available over-the-counter and should be used as directed, typically 1-2 drops in each affected eye twice daily.

Some key points to consider when using eye drops for allergic eye conditions include:

• Vasoconstrictors, such as naphazoline (AK-Con, Albalon) or tetrahydrozoline (Visine), can provide relief of ocular redness but do not reduce the allergic response and may lead to rebound hyperemia or conjunctivitis medicamentosa with prolonged use 1.
• Antihistamines, such as emedastine (Emadine) or levocabastine (Livostin), can provide relief of ocular allergy symptoms but may not be as effective as dual-action agents 1.
• Mast cell stabilizers, such as cromolyn (Opticrom) or lodoxamide (Alomide), have a slow onset of action and are more suitable for prophylactic or longer-term treatment of chronic ocular allergies 1.
• Corticosteroid eye drops, such as loteprednol etabonate (Alrex), should be reserved for more severe symptoms of allergic conjunctivitis due to the risk of vision-threatening side effects, including cataract formation, elevated IOP, and secondary infections 1.

In addition to using eye drops, other measures can help alleviate allergic eye symptoms, such as:

• Using artificial tears to flush allergens from the eyes and provide additional relief 1.
• Applying cold compresses to closed eyes for 5-10 minutes to temporarily reduce swelling and discomfort.
• Avoiding exposure to known allergens, such as pollen, pet dander, or dust mites. If symptoms persist beyond 2-3 days of treatment, worsen, or include vision changes or eye pain, medical attention should be sought as prescription corticosteroid drops might be necessary for short-term use 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. 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) twice daily, every 6 to 8 hours, no more than twice per day

The recommended eye drops for allergic eye conditions are:

• Loteprednol etabonate (2): for the treatment of seasonal allergic conjunctivitis, dosed four times per day.
• Ketotifen (3): put 1 drop in the affected eye(s) twice daily, every 8-12 hours.
• Olopatadine (4): put 1 drop in the affected eye(s) twice daily, every 6 to 8 hours.

From the Research

Recommended Eye Drops for Allergic Eye Conditions

The following are some of the recommended eye drops for allergic eye conditions:

• Topical antihistamines, such as olopatadine, ketotifen, and epinastine, which provide faster and superior relief than systemic antihistamines 5
• Mast cell stabilizers, such as sodium cromoglicate and lodoxamide, which may be considered for their anti-inflammatory properties in addition to mast cell stabilization 5
• Dual-action agents, such as olopatadine and ketotifen, which have both antihistamine and mast cell stabilizing properties 6, 7
• Topical NSAIDs, such as ketorolac, which may be used for ocular itching but have been found to be inferior to olopatadine and emedastine for relief of allergic conjunctivitis 5

Comparison of Efficacy and Tolerability

Studies have compared the efficacy and tolerability of different eye drops for allergic conjunctivitis, including:

• Olopatadine and cromolyn sodium, which showed that olopatadine had a significantly greater effect on ocular signs and symptoms than cromolyn sodium 6
• Epinastine, ketotifen, and olopatadine, which were found to have comparable efficacy to fluorometholone in the treatment of allergic conjunctivitis 7
• Ketotifen fumarate and olopatadine hydrochloride, which showed that ketotifen had a higher responder rate and global efficacy ratings than olopatadine 8

Considerations for Treatment

When selecting an eye drop for allergic conjunctivitis, considerations should include:

• The mechanism of action of the medication, such as antihistamine or mast cell stabilizing properties 5
• The potential for adverse effects, such as burning or stinging 8
• The patient's individual needs and preferences, such as comfort and ease of use 9
• The presence of comorbidities, such as dry eye disease, which may affect the choice of treatment 9