Over-the-Counter Eye Drops for Allergic Conjunctivitis
For an adult with allergic conjunctivitis causing watery eyes who wears contact lenses, start with ketotifen or olopatadine dual-action eye drops, both available over-the-counter and safe for contact lens wearers. 1, 2, 3
First-Line Pharmacological Treatment
Dual-action antihistamine/mast cell stabilizers are the most effective first-line treatment because they provide rapid symptom relief (onset within 30 minutes) while simultaneously preventing future allergic episodes through mast cell stabilization. 1, 2
Recommended OTC Options:
- Ketotifen (now OTC): Provides up to 12 hours of relief, approved for ages 3 years and older, original prescription strength now available without prescription 3
- Olopatadine 0.2%: Superior efficacy for both itching and redness, maintains effectiveness for at least 8 hours with twice-daily dosing 2, 4
- Epinastine 0.05%: Effective alternative, though olopatadine demonstrates superior reduction of both itching and redness in head-to-head comparisons 5
- Azelastine: Another dual-action option with rapid onset 1, 6
Contact Lens Compatibility:
All dual-action agents listed above can be used by contact lens wearers, though you should instill drops before inserting lenses or wait 10 minutes after instillation before lens insertion. 1
Adjunctive Non-Pharmacological Measures
Refrigerated preservative-free artificial tears 4 times daily help dilute allergens and inflammatory mediators on the ocular surface, providing additional symptomatic relief. 1, 2
Additional supportive measures include:
- Cold compresses for immediate symptomatic relief 1, 2
- Storing eye drops in the refrigerator provides additional cooling relief upon instillation 1
- Wearing sunglasses as a physical barrier against airborne allergens 1
- Avoiding eye rubbing, which worsens symptoms and can lead to keratoconus in susceptible patients 1
Critical Pitfalls to Avoid
Never use over-the-counter antihistamine/vasoconstrictor combinations (such as naphazoline/pheniramine) for more than 10 days because prolonged vasoconstrictor use causes rebound hyperemia (conjunctivitis medicamentosa), creating a cycle of worsening redness. 1, 7
Avoid oral antihistamines as primary treatment because they worsen dry eye syndrome and impair the tear film's protective barrier, potentially exacerbating watery eye symptoms. 1, 2
Do not use topical antibiotics for allergic conjunctivitis—they provide no benefit for allergic disease, induce toxicity, and contribute to antibiotic resistance. 1
When to Escalate Treatment
If symptoms do not improve within 48 hours on dual-action drops, consider:
- Adding preservative-free lubricants 2-4 times daily in combination with the dual-action agent 1
- Seeking medical evaluation for possible prescription of a brief (1-2 week maximum) course of topical corticosteroids such as loteprednol etabonate 1, 2
Seek ophthalmology evaluation promptly if you develop visual loss, moderate-to-severe pain, abundant purulent discharge, or no improvement within 48 hours, as these may indicate a more serious condition requiring specialist care. 7
Duration of Treatment
Unlike topical corticosteroids or vasoconstrictors, dual-action agents have no specified maximum treatment duration and can be used throughout the allergy season or year-round for perennial allergic conjunctivitis without the risks associated with other drug classes. 2
For seasonal allergic conjunctivitis, continue treatment as long as allergen exposure persists, with reassessment at regular intervals based on symptom control. 1