From the Guidelines
Allergic conjunctivitis should be treated with dual-action agents that possess both antihistamine and mast cell stabilizer activities, such as olopatadine (Patanol) or epinastine (Elestat), as they have been shown to be more effective in preventing or treating ocular itching than other ocular agents 1.
Diagnosis
Allergic conjunctivitis is an eye inflammation caused by an allergic reaction to substances like pollen, pet dander, or dust mites. Symptoms typically include:
- Itching
- Redness
- Tearing
- Swelling of the conjunctiva These symptoms can be diagnosed through a comprehensive eye examination and medical history.
Treatment
For treatment, the following approaches can be used:
- Non-medication approaches:
- Avoiding allergens
- Using cold compresses
- Artificial tears
- Over-the-counter antihistamine eye drops like ketotifen (Zaditor, Alaway) can be used twice daily for symptom relief
- Prescription antihistamine/mast cell stabilizer drops such as olopatadine (Patanol) or epinastine (Elestat) used twice daily are effective for moderate cases
- Severe cases may require short courses of topical corticosteroid drops like loteprednol 0.2% (Alrex) four times daily for 1-2 weeks, but these should be used under medical supervision due to potential side effects 1
- Oral antihistamines like cetirizine (10mg daily) or loratadine (10mg daily) can complement topical therapy
Management
It is essential to note that:
- Vasoconstrictors can lead to rebound hyperemia or conjunctivitis medicamentosa with prolonged use
- Mast cell stabilizers have a slow onset of action and may require several days of treatment before optimal symptom relief is achieved
- Topical NSAIDs like ketorolac can reduce prostaglandin production involved in mediating ocular allergy
- Ocular corticosteroids should be reserved for more severe symptoms of allergic conjunctivitis due to potential vision-threatening side effects 1 If symptoms persist beyond 1-2 weeks of treatment or if vision changes occur, medical evaluation is necessary.
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 diagnosis of allergic conjunctivitis is not explicitly stated in the provided drug labels. The treatment for allergic conjunctivitis is loteprednol etabonate ophthalmic suspension, as it is indicated for the treatment of steroid-responsive inflammatory conditions, including allergic conjunctivitis 2 2.
From the Research
Diagnosis of Allergic Conjunctivitis
- The diagnosis of allergic conjunctivitis involves identifying the symptoms and signs of the condition, such as itching, tearing, redness, and swelling of the eyes 3, 4.
- A thorough medical history and physical examination are essential in diagnosing allergic conjunctivitis 4.
- In some cases, a conjunctival allergen provocation test may be performed to confirm the diagnosis 4.
- It is also important to rule out other forms of conjunctivitis, such as perennial allergic conjunctivitis, vernal keratoconjunctivitis, or atopic keratoconjunctivitis 3, 4.
Treatment of Allergic Conjunctivitis
- The treatment of allergic conjunctivitis depends on the severity of the symptoms and may involve a combination of non-pharmacological and pharmacological approaches 3, 4, 5, 6.
- Non-pharmacological treatments include avoiding allergens, using lubricating agents, and protecting the ocular surface 4.
- Pharmacological treatments may include:
- Antihistamines and mast cell stabilizers, such as ketotifen fumarate and olopatadine HCl, which have dual action and are effective in reducing symptoms 5.
- Corticosteroids, such as loteprednol etabonate, which are effective in reducing inflammation and symptoms, but may have side effects 7, 6.
- Immunotherapy, which may be considered for severe cases 6.
- In severe cases, comanagement with an ophthalmologist may be necessary 3.
- The choice of treatment should be based on the individual patient's needs and the severity of their symptoms 3, 4, 5, 6.