Prescription-Only Eye Drops for Allergic Conjunctivitis
Olopatadine (Patanol, Pataday) is the most effective first-line prescription eye drop for allergic conjunctivitis, with superior efficacy in controlling ocular itching and other allergic symptoms. 1
First-Line Prescription Options
Dual-action antihistamine/mast cell stabilizers are the preferred prescription medications for allergic conjunctivitis due to their ability to provide both immediate symptom relief and prevention:
- Olopatadine (0.1% Patanol or 0.2% Pataday) - first-line therapy
- Epinastine (Elestat)
- Ketotifen (Zaditor)
- Azelastine (Optivar)
These medications work by both blocking histamine receptors to reduce itching and redness, while also stabilizing mast cells to prevent the release of inflammatory mediators. 1
Second-Line Prescription Options
If dual-action agents are ineffective or unavailable, these prescription-only options can be considered:
Pure antihistamines:
- Emedastine (Emadine)
- Levocabastine (Livostin)
Pure mast cell stabilizers:
- Lodoxamide (Alomide)
- Nedocromil (Alocril)
- Pemirolast (Alamast)
Mast cell stabilizers have a slower onset of action (several days) and are better suited for prophylactic or long-term treatment rather than acute symptom relief. 2, 1
For Severe Symptoms
Loteprednol etabonate (Alrex) is the preferred prescription corticosteroid for short-term treatment (1-2 weeks) of severe allergic conjunctivitis. 2, 1, 3
Key advantages of loteprednol etabonate include:
- Designed as a "soft drug" that undergoes predictable metabolism to inactive metabolites
- Lower risk of elevating intraocular pressure compared to other ocular corticosteroids
- Effective for reducing signs and symptoms of seasonal allergic conjunctivitis 4, 5
- Only 1.7% of patients experience clinically significant IOP increases (≥10 mmHg) with prolonged use 6
Important Considerations
Monitoring: If corticosteroids like loteprednol are prescribed, baseline and periodic measurement of intraocular pressure should be performed to evaluate for glaucoma. 1
Contraindications:
- Oral antihistamines may worsen dry eye syndrome
- Chronic use of vasoconstrictors can lead to rebound vasodilation
- Contact lens wearers should remove lenses before instilling drops and wait at least 5 minutes before reinsertion 1
Duration of therapy: Corticosteroids should be limited to short-term use (1-2 weeks) to minimize risk of side effects including cataract formation, elevated IOP, and secondary infections. 2, 1