From the Guidelines
Allergic conjunctivitis can be effectively treated with a combination of avoidance strategies and medications, with dual-action agents such as olopatadine (Patanol) or epinastine (Elestat) being the most effective option for acute and longer-term treatment of allergic conjunctivitis symptoms, as supported by the most recent study 1. The treatment approach should prioritize the use of topical medications, as they are more effective in relieving ocular allergy symptoms than oral antihistamines, which can also induce or worsen dry eye syndrome and impair the tear film’s protective barrier 1. Some key considerations for treatment include:
- Avoiding allergens that trigger symptoms
- Using over-the-counter antihistamine eye drops like ketotifen (Zaditor, Alaway) for immediate relief
- Utilizing prescription antihistamine/mast cell stabilizer combination drops for moderate symptoms
- Reserving topical corticosteroid drops like loteprednol (Alrex) for severe cases, under medical supervision
- Applying cold compresses to reduce itching and swelling
- Avoiding eye rubbing to prevent worsening of symptoms The most effective treatment options, as recommended by the latest guidelines 1, include:
- Dual-action agents that combine antihistamine and mast cell stabilizer activities
- Topical mast-cell inhibitors for alleviating symptoms of allergic rhinitis
- Refrigerated artificial tears to provide symptomatic relief It is essential to note that the use of vasoconstrictor agents can be associated with rebound vasodilation once the agent is stopped, and therefore, their chronic use should be avoided 1. In terms of specific medications, the following options are available:
- Antihistamines: ketotifen (Zaditor, Alaway), olopatadine (Patanol), epinastine (Elestat)
- Mast cell stabilizers: cromolyn (Opticrom, Crolom), lodoxamide (Alomide)
- Dual-action agents: olopatadine (Patanol), epinastine (Elestat), ketotifen (Alaway, Zaditor)
- Topical corticosteroids: loteprednol (Alrex), fluorometholone (FML) Ultimately, the treatment of allergic conjunctivitis should be tailored to the individual patient's needs, taking into account the severity of symptoms, the presence of any underlying conditions, and the potential risks and benefits of each treatment option, as supported by the latest study 1.
From the FDA Drug Label
Loteprednol etabonate ophthalmic suspension is indicated for the treatment of steroid-responsive inflammatory conditions of the palpebral and bulbar conjunctiva, cornea and anterior segment of the globe such as allergic conjunctivitis, acne rosacea, superficial punctate keratitis, herpes zoster keratitis, iritis, cyclitis, selected infective conjunctivitides, when the inherent hazard of steroid use is accepted to obtain an advisable diminution in edema and inflammation A placebo-controlled clinical study demonstrated that loteprednol etabonate was effective in reducing the signs and symptoms of allergic conjunctivitis during peak periods of pollen exposure.
The treatment for allergic conjunctivitis is loteprednol etabonate ophthalmic suspension 2 2.
- Key points:
- Loteprednol etabonate is indicated for the treatment of steroid-responsive inflammatory conditions, including allergic conjunctivitis.
- It is effective in reducing the signs and symptoms of allergic conjunctivitis during peak periods of pollen exposure.
From the Research
Treatment Options for Allergic Conjunctivitis
The treatment for allergic conjunctivitis includes various options, such as:
- Oral antihistamines, which are an excellent choice for controlling multiple early-phase and some late-phase allergic symptoms in the eyes, nose, and pharynx 3
- Topical antihistamines, which are often efficacious and superior to systemic antihistamines for isolated symptoms like ocular pruritus 3
- Topical vasoconstrictor agents, which provide rapid relief, especially for redness, but may lead to rebound hyperaemia and irritation with overuse 3
- Mast cell stabilizers, which may be considered but have a slower onset of action 3
- Topical NSAIDs, such as ketorolac, which have been found to be inferior to olopatadine and emedastine for relief of allergic conjunctivitis 3
- Topical corticosteroids, which may be considered for severe seasonal ocular allergy symptoms, but long-term use should be avoided due to risks of ocular adverse effects 3
Dual-Action Agents
Dual-action agents, such as olopatadine, azelastine, ketotifen, and epinastine, are commonly used for mild subtypes of allergic conjunctivitis and have been shown to be effective in treating signs and symptoms of the condition 4
- These agents have anti-inflammatory properties and may prevent activation of neutrophils, eosinophils, and macrophages, or inhibit release of leukotrienes, platelet-activating factors, and other inflammatory mediators 3, 4
- High-concentration olopatadine has been shown to have a longer duration of action and better efficacy on ocular itch compared to low-concentration olopatadine 4
Immunomodulators
Immunomodulators, such as cyclosporine A and tacrolimus, have been extensively studied in the therapy of severe conjunctivitis, including atopic and vernal keratoconjunctivitis, with promising results 5
- These agents may be considered for patients with severe allergic conjunctivitis who do not respond to other treatments 5
Comparison of Treatments
Studies have compared the efficacy of different treatments for allergic conjunctivitis, including ketotifen and olopatadine, and have found that both are effective in reducing symptoms and improving quality of life 6, 7
- Ketotifen and olopatadine have been shown to diminish the expression of cell adhesion molecules and inflammatory markers on the conjunctival surface cells effectively 6
- Loteprednol etabonate, a novel corticosteroid, has been found to have a similar efficacy to traditional corticosteroids in preventing or treating the signs and symptoms of seasonal allergic conjunctivitis, but with a greatly improved safety profile 7