From the Guidelines
Antihistamine eye drops are the most effective treatment for eye allergies, and dual-action agents such as azelastine (Optivar), epinastine (Elestat), ketotifen (Alaway, Zaditor), and olopatadine (Pataday, Patanol) are recommended for their rapid onset of action and ability to relieve symptoms like itching, redness, and watering. These agents possess both antihistamine and mast cell stabilizer activities, making them suitable for acute and longer-term treatment of allergic conjunctivitis symptoms 1.
When choosing an antihistamine eye drop, it is essential to consider the classification of the medication, with options including antihistamines like emedastine (Emadine) and levocabastine (Livostin), combination antihistamine/vasoconstrictors like antazoline (Vasocon-A) and pheniramine (Visine-A, Naphcon-A, Opcon-A, Nafazair-A), and dual-action agents like azelastine (Optivar) and olopatadine (Pataday, Patanol) 1.
Some key points to consider when using antihistamine eye drops include:
- Applying the drops correctly by tilting your head back, pulling down your lower eyelid, placing one drop in the pocket, and closing your eyes for 1-2 minutes to minimize systemic absorption and prevent contamination 1
- Being aware of potential side effects like mild stinging, temporary blurred vision, or headaches, which are usually mild and self-limiting 1
- Not using ocular decongestants for more than 10 days to avoid rebound hyperemia or conjunctivitis medicamentosa 1
- Considering alternative treatments like mast cell stabilizers or corticosteroids for more severe or chronic symptoms, but only under the guidance of a healthcare provider due to potential vision-threatening side effects 1.
From the FDA Drug Label
Purpose Antihistamine Purpose Antihistamine and Redness Reliever
- Ketotifen (OPHTH) and olopatadine (OPHTH) are examples of antihistamine eye drops.
- These eye drops are used for their antihistamine properties, with olopatadine (OPHTH) also providing redness relief 2, 2, 3.
From the Research
Antihistamine Eye Drops
- Antihistamine eye drops are used to treat allergic conjunctivitis (AC), a common ocular inflammatory manifestation of allergen exposure in sensitized individuals 4.
- Dual-acting antihistamine-mast cell stabilizing agents are considered first-line therapeutics for AC because they provide acute relief of signs and symptoms and block persistent inflammation to promote regression of AC 4.
- Topical olopatadine and ketotifen are two commonly used antihistamine eye drops for the treatment of AC, with olopatadine providing quicker relief of symptoms and improving symptoms of AC and quality of life with fewer side effects compared to ketotifen 5.
Comparison of Antihistamine Eye Drops
- A study comparing topical olopatadine and ketotifen found that olopatadine significantly reduced itching, tearing, hyperemia, and total AC scores by the 4th day, and conjunctival papillae by the 15th day 5.
- Another study found that high-concentration olopatadine (0.77%) had a longer duration of action, better efficacy on ocular itch, and a similar safety profile to low-concentration olopatadine (0.2%) 6.
- A comparison of ketotifen fumarate and olopatadine hydrochloride found that ketotifen had a higher responder rate and better global efficacy ratings, but both drugs had comparable comfort ratings 7.
Efficacy and Safety
- Antihistamine eye drops have been shown to be effective in reducing the symptoms of AC, including itching, tearing, and redness 4, 5, 6.
- The safety profiles of antihistamine eye drops, such as olopatadine and ketotifen, have been found to be similar, with few adverse events reported 5, 7, 8.
- The expression of cell adhesion molecules and inflammatory markers in conjunctival surface cells has been found to be significantly reduced with the use of antihistamine eye drops, such as ketotifen and olopatadine 8.