What are the options for allergy eye drops (ophthalmic anti-allergic medications)?

From the Guidelines

For mild to moderate allergy symptoms, I recommend starting with antihistamine/mast cell stabilizer combination drops like olopatadine (Pataday) used once daily, as it has been shown to be effective in preventing or treating ocular itching 1.

Key Considerations

• These medications work by blocking histamine receptors and preventing the release of inflammatory chemicals from mast cells.
• For severe symptoms, prescription-strength options like olopatadine 0.7% (Pazeo) may be more effective.
• Apply the drops as directed, avoiding touching the tip to prevent contamination, and wash hands before application.
• If you wear contact lenses, remove them before using drops and wait 10-15 minutes before reinserting.
• If symptoms persist beyond 72 hours of treatment, or if you experience vision changes, eye pain, or discharge, consult an eye care professional.

Additional Relief

• Artificial tears can be used alongside allergy drops to provide additional relief by washing away allergens and lubricating the eye surface.
• Other measures such as wearing sunglasses, cold compresses, and avoiding eye rubbing may also be helpful in alleviating symptoms 1.

Important Notes

• Vasoconstrictors are available over-the-counter but should be used with caution as prolonged use can lead to rebound hyperemia or conjunctivitis medicamentosa 1.
• Mast cell stabilizers have a slow onset of action and may require several days of treatment before optimal symptom relief is achieved, making them more suitable for prophylactic or longer-term treatment of chronic ocular allergies 1.

From the FDA Drug Label

Directions Adults and children 3 years of age and older: Put 1 drop in the affected eye(s) twice daily, every 8-12 hours, no more than twice per day. Directions adults and children 2 years of age and older: put 1 drop in the affected eye(s) twice daily, every 6 to 8 hours, no more than twice per day if using other ophthalmic products while using this product, wait at least 5 minutes between each product ANTIHISTAMINE EYE DROPS UPTO 12 HOURS EYE ITCH RELIEF Ketotifen and olopatadine are two allergy eye drops available, with ketotifen suitable for ages 3 years and older, and olopatadine for ages 2 years and older.

• Dosage:
  • Ketotifen: 1 drop in the affected eye(s) twice daily, every 8-12 hours
  • Olopatadine: 1 drop in the affected eye(s) twice daily, every 6 to 8 hours
• Precautions:
  • Do not touch dropper tip to any surface to avoid contamination
  • Wait at least 5 minutes between each product if using other ophthalmic products 2 3 2

From the Research

Allergy Eye Drops

• Allergy eye drops are used to treat allergic conjunctivitis, with various mechanisms of action, including antihistamines and mast cell stabilizers 4, 5, 6, 7, 8
• Topical dual-action antihistamines/mast cell stabilizers, such as olopatadine, azelastine, ketotifen, and epinastine, are commonly used to treat mild subtypes of allergic conjunctivitis 4
• High-concentration olopatadine (0.77%) has been shown to have a longer duration of action, better efficacy on ocular itch, and a similar safety profile to low-concentration olopatadine (0.2%) 4
• Epinastine, ketotifen, and olopatadine have been found to be effective in treating allergic conjunctivitis, with comparable efficacy to fluorometholone 5, 6, 8
• Olopatadine has been shown to be more effective than cromolyn sodium in controlling ocular signs and symptoms of seasonal allergic conjunctivitis 7
• Ketotifen and olopatadine have been found to reduce the expression of cell adhesion molecules and inflammatory markers in conjunctival surface cells, with ketotifen showing a higher responder rate and better global efficacy ratings than olopatadine 6, 8

Comparison of Allergy Eye Drops

• Olopatadine and ketotifen have been compared in several studies, with varying results, but both have been shown to be effective in treating allergic conjunctivitis 6, 8
• Epinastine and olopatadine have been found to be more effective than placebo in treating allergic conjunctivitis symptoms, with epinastine showing superior efficacy to olopatadine in some studies 4, 5
• Cromolyn sodium has been compared to olopatadine, with olopatadine showing better efficacy in controlling ocular signs and symptoms of seasonal allergic conjunctivitis 7

Efficacy and Safety

• Allergy eye drops have been found to be well-tolerated, with few adverse events reported 5, 6, 7, 8
• Olopatadine and ketotifen have been shown to have good safety profiles, with few adverse events reported 6, 7, 8
• Epinastine and olopatadine have been found to be effective and well-tolerated in treating allergic conjunctivitis, with few adverse events reported 4, 5