From the Guidelines
For the treatment of allergic conjunctivitis, I strongly recommend starting with antihistamine/mast cell stabilizer combination drops like ketotifen (Zaditor, Alaway) or olopatadine (Pataday), used 1-2 times daily as directed on the package, due to their quick relief of itching, redness, and watering and prevention of inflammatory chemical release from mast cells 1.
Treatment Options
The treatment options for allergic conjunctivitis using eye drops include:
- Vasoconstrictors: available over-the-counter (OTC) for 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: available OTC and prescription, sometimes combined with a topical vasoconstrictor for acute relief of ocular allergy symptoms, with the combination working better than either agent alone 1
- Mast cell stabilizers: have a slow onset of action, making them more suitable for prophylactic or longer-term treatment of chronic ocular allergies, and are approved for chronic ocular allergy conditions involving corneal defects 1
- Topical NSAIDs: reduce prostaglandin production involved in mediating ocular allergy, with ketorolac indicated for temporary relief of ocular itching caused by seasonal allergic conjunctivitis 1
- Dual action agents: possess both antihistamine and mast cell stabilizer activities, have a quick onset of action, and are suitable for acute and longer-term treatment of allergic conjunctivitis symptoms 1
- Ocular corticosteroids: should be reserved for more severe symptoms of allergic conjunctivitis due to potential vision-threatening side effects, with the modified steroid loteprednol having a reduced risk of causing increased IOP compared to other ocular corticosteroids 1
Recommended Treatment Approach
For mild to moderate symptoms, antihistamine/mast cell stabilizer combination drops like ketotifen (Zaditor, Alaway) or olopatadine (Pataday) are recommended, used 1-2 times daily as directed on the package 1. For more severe symptoms, prescription-strength options like olopatadine 0.7% (Pataday Once Daily Relief Extra Strength) or bepotastine (Bepreve) may be more effective. Artificial tears can also help flush allergens from the eyes and provide additional relief when used alongside medicated drops. If symptoms persist beyond 72 hours of treatment or if you experience eye pain, vision changes, or discharge, consult a healthcare provider as these may indicate a more serious condition.
From the FDA Drug Label
CLINICAL PHARMACOLOGY Corticosteroids inhibit the inflammatory response to a variety of inciting agents and probably delay or slow healing. 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. DOSAGE AND ADMINISTRATION The dose is 1 or 2 drops in each eye 4 to 6 times a day at regular intervals. INDICATIONS AND USAGE Loteprednol Etabonate Ophthalmic Suspension, 0.2% is indicated for the temporary relief of the signs and symptoms of seasonal allergic conjunctivitis.
The treatment options for allergic conjunctivitis using eye drops are:
- Corticosteroids: such as loteprednol etabonate, which can provide relief from signs and symptoms of seasonal allergic conjunctivitis 2
- Mast cell stabilizers: such as cromolyn sodium, which can be used to treat allergic conjunctivitis, with a dose of 1 or 2 drops in each eye 4 to 6 times a day 3
- Loteprednol etabonate: specifically indicated for the temporary relief of the signs and symptoms of seasonal allergic conjunctivitis 2
From the Research
Treatment Options for Allergic Conjunctivitis
The treatment options for allergic conjunctivitis using eye drops include:
- Antihistamines, which are safe and reasonably effective 4, 5, 6
- Mast cell stabilizers, which are safe, effective, and an important component of antiallergic therapy 4, 7, 6
- Nonsteroidal anti-inflammatory drugs, which have antiallergic effects 4, 6
- Corticosteroids, which are more potent than other antiallergic drugs, but have attendant side effects that need to be monitored by an ophthalmologist 4, 6
- Cromoglycate, which is used to treat seasonal atopic conjunctivitis 7, 8
Specific Treatment Options for Different Types of Allergic Conjunctivitis
- Seasonal atopic conjunctivitis: antihistamines, cromoglycate, and short courses of corticosteroids 7, 8
- Perennial allergic conjunctivitis: longer therapy with mast cell stabilizers and sometimes local steroids 8
- Atopic keratoconjunctivitis: long-term treatment with corticosteroid and, if necessary, cyclosporine eye drops 7
- Vernal conjunctivitis: mast cell stabilizers and, if necessary, corticosteroid eye drops 7
- Non-allergic eosinophilic conjunctivitis: mast cell stabilizers, corticosteroid, and, if necessary, cyclosporine eye drops 7