What eye ointment can be used for relief from itching eyes?

Eye Ointments for Itching Relief

For itching eyes, tacrolimus 0.1% ointment is the most effective treatment option with 89% of patients experiencing good or very good response, followed by corticosteroid eyedrops (74% response rate) and ocular lubricants (65% response rate). 1

First-Line Treatment Options

Ocular Lubricants

• Preservative-free hyaluronate drops are recommended as first-line treatment for mild eye itching 1
• Apply one drop to each eye 2-4 times daily 1
• Refrigerated preservative-free artificial tears can dilute allergens and inflammatory mediators 2
• Formulations with higher hyaluronate percentage offer greater therapeutic efficacy for more severe symptoms 1

Dual-Action Agents

• Dual-action agents (antihistamine + mast cell stabilizer) such as olopatadine, ketotifen, epinastine, and azelastine are the most effective first-line pharmacological treatments for allergic conjunctivitis 2, 3
• These medications have rapid onset of action (within 30 minutes) and can both treat acute symptoms and prevent future episodes 3
• Olopatadine 0.1% ophthalmic solution has been shown to effectively control both ocular and nasal symptoms of allergic conjunctivitis when administered twice daily 4

Second-Line Treatment Options

Antihistamine Eyedrops

• If lubricants are not effective or ocular inflammation is moderate, olopatadine eyedrops may be tried twice daily in addition to ocular lubricants 1
• Treatment should be assessed after 1 month; lack of response warrants ophthalmology referral 1
• Antihistamines alone have a lower response rate (42%) compared to other treatment options 1

Mast Cell Stabilizers

• Mast cell stabilizers such as cromolyn, lodoxamide, nedocromil, and pemirolast are better for prophylactic or longer-term treatment 2, 3
• These have a slower onset of action (several days) compared to antihistamines 3

Third-Line Treatment Options

Tacrolimus Ointment

• Tacrolimus 0.1% ointment has shown the highest response rate (89%) for treating ocular surface disorders 1
• Apply once daily to the external eyelids and lid margins for 2-4 weeks 1
• Can be applied directly to the ocular surface of the lids for best effect (off-license use) 1
• Not recommended for patients with history of ocular-surface herpes simplex virus or varicella zoster virus 1
• For children aged 2-17 years, start with tacrolimus 0.03% ointment; 0.1% can be used in appropriate cases with ophthalmology advice 1

Corticosteroid Eyedrops

• Corticosteroid eyedrops have shown good response rates (74%) but should be reserved for severe symptoms 1, 2
• Use should be limited to 1-2 weeks due to risks of increased intraocular pressure, cataract formation, and secondary infections 2, 3
• Loteprednol etabonate has a lower side effect profile compared to other corticosteroids 3

Ciclosporin Eyedrops

• Ciclosporin eyedrops have shown a 63% response rate 1
• Licensed for severe keratitis in dry eye disease that hasn't responded to tear substitutes 1
• Should usually be initiated by ophthalmologists 1

Additional Supportive Measures

Lid Hygiene Measures

• For blepharitis or lid margin disease, lid hygiene measures can be helpful (50% response rate) 1
• Apply warm compresses to closed eyes followed by eyelid massage to soften oils 1
• Clean eyelid margins with homemade bicarbonate solution or commercially available lid wipes 1
• Not recommended for children as they are unlikely to adhere to the regimen 1

Important Considerations and Precautions

• Avoid prolonged use of vasoconstrictors as they can lead to rebound hyperemia 2, 3
• Oral antihistamines may worsen dry eye syndrome and impair the tear film's protective barrier 2, 3
• For children under 7 years, consult ophthalmology before initiating treatment 1
• Avoid using flannel soaked in hot water for warm compresses due to scalding risk; use specially designed devices instead 1
• Eye drops should always be instilled before applying eye ointment, as ointment will affect absorption of eye drops 5