What are the acute medications used for eye irritation?

Acute Medications for Eye Irritation

For eye irritation, the first-line treatment is preservative-free ocular lubricants (artificial tears), which should be applied every 2-4 hours to dilute allergens and inflammatory mediators on the ocular surface. 1, 2

First-Line Treatments

• Apply preservative-free hyaluronate or carmellose eye drops every 2 hours for acute eye irritation; formulations with higher hyaluronate percentage offer greater efficacy for more severe cases 1
• Use cold compresses for several minutes to reduce inflammation and provide symptomatic relief 3, 2
• Refrigerated preservative-free artificial tears help dilute allergens and inflammatory mediators while providing additional comfort 2, 4
• Avoid eye rubbing which can worsen symptoms and potentially lead to keratoconus 3, 2

Second-Line Treatments Based on Cause

For Allergic Eye Irritation

• Dual-action agents (antihistamine + mast cell stabilizer) such as olopatadine, ketotifen, epinastine, or azelastine are most effective for allergic conjunctivitis 3, 2, 5
• Apply these medications twice daily for rapid symptom relief (within 30 minutes) 2
• For eyelid skin involvement, tacrolimus 0.03-0.1% ointment can be applied once daily to the external eyelids 1, 3
  • Use 0.03% for children 2-15 years old
  • Use 0.03% or 0.1% for patients 16 years and older

For Dry Eye-Related Irritation

• If symptoms persist despite lubricants, consider punctal occlusion when medical means of aqueous enhancement are ineffective 1
• For moderate to severe dry eye, topical cyclosporine 0.05% twice daily has shown success rates of 67-74% across severity levels 1
• Lifitegrast 5% may be beneficial for both signs (corneal and conjunctival staining) and symptoms (eye dryness and discomfort) 1

Third-Line Treatments for Severe or Persistent Cases

• For severe symptoms or acute exacerbations, a brief course (1-2 weeks) of topical corticosteroids with a low side effect profile can be added 1, 2
  • Nonpreserved dexamethasone 0.1% twice daily may reduce ocular surface damage 1
  • Loteprednol etabonate 0.5% is preferred due to lower risk of intraocular pressure elevation 1
• For corneal fluorescein staining or ulceration, administer a broad-spectrum topical antibiotic as prophylaxis (e.g., moxifloxacin drops four times daily) 1

Special Considerations and Pitfalls

• Avoid preservative-containing formulations as they can cause additional irritation 6, 7
• Oral antihistamines are commonly used but may worsen dry eye syndrome and impair the tear film's protective barrier 1, 2
• Avoid prolonged use of vasoconstrictors as they can lead to rebound hyperemia 2
• Monitor patients on topical corticosteroids for increased intraocular pressure and cataract formation 1
• For severe or refractory cases, consultation with an ophthalmologist is recommended 1, 2

Environmental Modifications

• Maintain adequate humidity in the environment, as low humidity can worsen eye irritation symptoms 4
• Take frequent breaks during intensive computer work to maintain normal eye blink frequency 4
• Consider hypoallergenic bedding, frequent clothes washing, and bathing before bedtime if allergies are suspected 3