Pataday (Olopatadine) for Allergic Conjunctivitis
Pataday (olopatadine) is recommended as first-line treatment for allergic conjunctivitis, dosed as 1 drop in affected eye(s) twice daily, every 6-8 hours, for patients 2 years and older. 1
Rationale for First-Line Use
Dual-action agents like olopatadine are the most effective first-line pharmacological treatment for allergic conjunctivitis according to the American Academy of Allergy, Asthma, and Immunology, combining both antihistamine and mast cell stabilizer properties 2, 3
Olopatadine provides rapid onset of action within 30 minutes and maintains efficacy for at least 8 hours, making it suitable for both acute symptom relief and longer-term prophylactic treatment 2
The mast cell stabilizing properties make olopatadine particularly appropriate for chronic, ongoing treatment rather than just acute symptom management 2
FDA-Approved Dosing and Administration
Adults and children ≥2 years: Instill 1 drop in affected eye(s) twice daily, every 6-8 hours, no more than twice per day 1
Children <2 years: Consult a physician before use 1
If using other ophthalmic products concurrently: Wait at least 5 minutes between each product 1
Replace cap after each use 1
Clinical Indications
Olopatadine temporarily relieves itchy and red eyes due to pollen, ragweed, grass, animal hair and dander 1
Unlike topical corticosteroids or vasoconstrictors, olopatadine has no specified maximum treatment duration, supporting extended use without the risks of increased intraocular pressure, cataract formation, or rebound hyperemia 2
Practical Considerations
Store in refrigerator for additional cooling relief upon instillation, which can enhance patient comfort 3
Olopatadine 0.2% is safe to use in patients with mild-to-moderate dry eye, showing no significant changes in dry eye signs or symptoms 4
The medication demonstrates superior efficacy compared to epinastine 0.05% in preventing ocular itching at 5 and 7 minutes post-challenge, and was rated as significantly more comfortable at 1 minute post-instillation 5
Treatment Algorithm Position
First-line: Olopatadine (dual-action agent) for most patients with allergic conjunctivitis 2, 3
Adjunctive measures: Cold compresses and refrigerated preservative-free artificial tears for additional symptom relief 2, 3
Second-line: Topical NSAIDs (ketorolac) for temporary relief if first-line inadequate 2
Third-line: Brief course (1-2 weeks only) of topical corticosteroids (loteprednol etabonate) for severe symptoms, with mandatory IOP monitoring 2, 3
Critical Pitfalls to Avoid
Avoid oral antihistamines as primary treatment for ocular symptoms, as they may worsen dry eye syndrome and impair the tear film's protective barrier 3, 6
Avoid prolonged vasoconstrictor use, which can cause rebound hyperemia (conjunctivitis medicamentosa) 2, 3
Do not use punctal plugs in allergic conjunctivitis, as they prevent flushing of allergens and inflammatory mediators from the ocular surface 3
Counsel patients to avoid eye rubbing, which can worsen symptoms and potentially lead to keratoconus, especially in atopic patients 3