From the Guidelines
Allergic conjunctivitis can be effectively treated with a combination of avoidance strategies and medications, with dual-action agents like olopatadine (Pataday) being the most effective option for acute and longer-term treatment. For immediate relief, over-the-counter antihistamine eye drops like ketotifen (Zaditor, Alaway) can be used twice daily, or olopatadine (Pataday) once daily 1. Cold compresses applied to closed eyes for 5-10 minutes several times daily can reduce itching and swelling. Artificial tears used 4-6 times daily help flush allergens and provide lubrication.
Key Considerations
- Avoidance of allergens that trigger symptoms is crucial in managing allergic conjunctivitis 1.
- Topical medications like antihistamines, mast cell stabilizers, and dual-action agents are more effective than oral antihistamines for relieving ocular allergy symptoms 1.
- Oral antihistamines like loratadine (10mg daily) or cetirizine (10mg daily) can supplement eye drops for systemic relief but may induce or worsen dry eye syndrome 1.
- Topical corticosteroids like loteprednol (Alrex) can be used for short-term treatment of moderate to severe cases but should be reserved for severe symptoms due to potential side effects 1.
Treatment Options
- Dual-action agents: olopatadine (Pataday), ketotifen (Zaditor, Alaway) 1
- Antihistamine eye drops: ketotifen (Zaditor, Alaway), levocabastine (Livostin) 1
- Mast cell stabilizers: cromolyn (Opticrom, Crolom), lodoxamide (Alomide) 1
- Topical corticosteroids: loteprednol (Alrex) 1
Additional Measures
- Wear sunglasses outdoors to reduce exposure to airborne allergens 1.
- Avoid rubbing eyes as this can worsen symptoms 1.
- Use hypoallergenic bedding, eyelid cleansers, and frequent clothes washing to reduce allergen exposure 1.
From the FDA Drug Label
CLINICAL PHARMACOLOGY Corticosteroids inhibit the inflammatory response to a variety of inciting agents and probably delay or slow healing. INDICATIONS AND USAGE Loteprednol Etabonate Ophthalmic Suspension, 0.2% is indicated for the temporary relief of the signs and symptoms of seasonal allergic conjunctivitis. Clinical Studies:In two double-masked, placebo-controlled six-week environmental studies of 268 patients with seasonal allergic conjunctivitis, Loteprednol Etabonate Ophthalmic Suspension, 0. 2%, when dosed four times per day was superior to placebo in the treatment of the signs and symptoms of seasonal allergic conjunctivitis.
Treatment of Allergic Conjunctivitis: Loteprednol Etabonate Ophthalmic Suspension, 0.2% is indicated for the temporary relief of the signs and symptoms of seasonal allergic conjunctivitis 2. The medication has been shown to provide reduction in bulbar conjunctival injection and itching, beginning approximately 2 hours after instillation of the first dose and throughout the first 14 days of treatment 2.
- Key Benefits:
- Reduction in bulbar conjunctival injection
- Reduction in itching
- Dosage: Four times per day 2.
From the Research
Treatment Options for Allergic Conjunctivitis
- Topical antihistamines, such as olopatadine and ketotifen, are effective in relieving symptoms of allergic conjunctivitis, including itching, redness, and tearing 3, 4, 5.
- Mast cell stabilizers, such as cromolyn sodium, can also be used to treat allergic conjunctivitis, although they may have a slower onset of action 3, 6.
- Topical corticosteroids may be considered for severe cases of allergic conjunctivitis, but their use should be limited due to the risk of ocular adverse effects, such as glaucoma and cataract formation 3, 7.
- Vasoconstrictor agents can provide rapid relief of redness, but their use should be limited due to the risk of rebound hyperaemia and irritation 3.
Comparison of Treatment Options
- Olopatadine has been shown to be more effective than ketotifen in relieving symptoms of allergic conjunctivitis, with fewer side effects 4, 5.
- Olopatadine has also been shown to be more effective than cromolyn sodium in relieving symptoms of allergic conjunctivitis, with better local tolerability in children aged <11 years 6.
- The choice of treatment should be based on the severity of the patient's symptoms and the presence of any comorbidities, such as asthma or eczema 7.
Management of Allergic Conjunctivitis
- A proactive approach to managing allergic conjunctivitis is recommended, with anticipation of regional allergen spikes and use of topical medications, such as antihistamines and/or mast cell stabilizers, as needed 7.
- Patient education and lifestyle modification, such as avoiding allergens and using lubricating agents, can also be helpful in managing allergic conjunctivitis 7.
- Comanagement with an ophthalmologist may be recommended for moderate-to-severe cases of allergic conjunctivitis, especially chronic vernal keratoconjunctivitis, atopic keratoconjunctivitis, and giant papillary conjunctivitis 7.