Article Date: 8/1/2002

Preventing, Controlling and Treating Ocular Allergies

This update will review some of the eye drops available to treat ocular allergy, as well as provide you with tips and information to share with your patients.

Undoubtedly you see many patients who suffer from allergies. Maybe you or your family members endure itchy, red eyes and post-nasal drip caused by allergens. This month's allergy update will review the available eye drops that you commonly use -- and maybe some that you don't -- to help your patients -- and even yourself -- manage the symptoms of ocular allergy.

This article will also recap some facts that you may want to pass on to your patients about allergies as well as how to handle allergens during the four seasons.

Topical Antihistamines

Emedastine difumarate
(Emadine) by Alcon

  • 1 drop in affected eye(s) up to q.i.d.

Levocabastine HCl
(Livostin) by Novartis

  • 1 drop in affected eye(s) q.i.d. for up to 2 weeks

Know your drops

Eye drops for ocular allergy fall into five pharmacological classes of drugs: topical antihistamines, topical mast cell stabilizers, topical antihistamines/mast cell stabilizers, topical NSAIDs and topical corticosteroids.

Topical antihistamines are indicated for the temporary relief of the signs and symptoms of seasonal conjunctivitis, which include ocular redness, swelling and itching.

In contrast, mast cell stabilizers don't relieve existing symptoms, but they do prevent them from occurring. Here's what available:

Mast cell stabilizers reduce the amount of degranulation and histamine that the mast cells release.


Topical Mast Cell Stabilizers

Pemirolast potassium
(Alamast) by Santen

  • 1 to 2 drops in affected eye(s) q.i.d.

Cromolyn sodium
(Crolom) by Bausch & Lomb

  • 1 or 2 drops in each eye 4 to 6 x's a day

Lodoxamide tromethamine
(Alomide) by Alcon

  • 1 to 2 drops q.i.d. for up to 3 mos.

Nedocromil sodium
(Alocril) by Allergan

  • 1 to 2 drops in each eye b.i.d.

Before actually having a problem, patients must take mast cell stabilizers regularly and prophylactically to prevent mast cell degranulation.

Now that we've covered antihistamines and mast cell stabilizers, let's look at what's available as a dual-acting compound.

Topical Antihistamines/Mast Cells Stabilizers

Olopatadine HCl (Patanol) by Alcon

  • 1 to 2 drops in each affected eye b.i.d. every 6 to 8 hours

Ketotifen fumarate
(Zaditor) by Novartis

  • 1 drop in affected eye(s) every 8 to 12 hours.

Azelastine HCl (Optivar) by Muro Pharmaceutical

  • 1 drop in affected eye b.i.d.


These drops combine the fast response of antihistamines with the prolonged action of mast cell stabilizers.

Another drop that decreases the itchiness of allergic conjunctivitis is the nonsteroidal anti-inflammatory drug (NSAID).

NSAIDs inhibit the cyclooxygenase pathway, causing a decrease in the production of prostaglandins and thromboxane. Keep in mind that NSAIDs can delay corneal wound healing.

You can also choose a topical corticosteroid for your allergy patients. As this drug is a topical steroid, only prescribe it when severe allergic conjunctivitis doesn't respond to other treatments.

Gauge each patient's condition and choose the eye drop that you think will benefit him most.


Topical NSAID

(Acular, Acular PF) by Allergan

  • 1 drop in affected eye(s) q.i.d.



Loteprednol etabonate
(Alrex) by Bausch & Lomb
  • 1 drop q.i.d.

(Vexol) by Alcon

  • 1 to 2 drops q.i.d.

(FML) by Allergan

  • 1 drop b.i.d. to q.i.d.

Prednisolone acetate
(Pred Forte) by Allergan

  • 1 to 2 drops b.i.d. to q.i.d.


Help Your Patients Learn to Love the Change of Seasons

Most people associate allergies with spring, but there's plenty of allergens to worry about in the summer, winter and fall. If you have patients who suffer from allergies, you may want to share this information with them to help them better manage the condition.

Remind them that regardless of the season, and whether they're spending more time indoors or out, they have to be aware of their surroundings so they know whether to expect problems to arise.

Spring & Summer Allergies

When it's warm out, most people are outside enjoying the weather. Here are some precautions you can take to limit your exposure to allergens.

Fall & Winter Allergies

With colder weather, people tend to stay indoors more. Here are some tips to making your home less allergen friendly:

Year-Round Allergies

More tips for managing allergies any time of year:

Here are some other ways to minimize or avoid allergic rhinitis reactions:

Share these tips with your patients so they can contribute to the prevention and management of their own allergies.


Optometric Management, Issue: August 2002