Eye drops for allergic conjunctivitis
Allergic conjunctivitis can be the predominant symptom in allergic rhinitis (also known as allergic rhinoconjunctivitis). Therapy with oral antihistamines or intranasal corticosteroids and saline eye drops or eye washes is effective for allergic conjunctivitis; eye drops can be used if symptoms do not respond.
Drugs used in eye drops for allergic conjunctivitis include:
- antihistamines (levocabastine1), which provide rapid relief of symptoms
- mast cell stabilisers (cromoglycate, lodoxamide), which have a delayed onset (around 2 weeks) but provide longer-term relief of symptoms
- drugs with both antihistamine and mast cell stabilising properties (azelastine, ketotifen, olopatadine), which provide both short- and long-term relief of symptoms.
Drugs with both antihistamine and mast cell stabilising properties appear to be more effective than drugs with only antihistamine or mast cell stabilising properties. Use:
1 azelastine 0.05% eye drops, 1 drop into both eyes, 2 to 4 times daily allergic conjunctivitis azelastine
OR
1 ketotifen 0.025% eye drops, 1 drop into both eyes, twice daily allergic conjunctivitis ketotifen
OR
1 olopatadine 0.1% eye drops, 1 drop into both eyes, twice daily. allergic conjunctivitis olopatadine
If an antihistamine eye drop is preferred, use:
1 levocabastine 0.05% eye drops, 1 drop into both eyes, 2 to 4 times daily. allergic conjunctivitis levocabastine
If a mast cell stabiliser eye drop is preferred, use:
1 cromoglycate 2% eye drops, 1 drop into both eyes, 4 to 6 times daily allergic conjunctivitis cromoglycate
OR
1 lodoxamide 0.1% eye drops, 1 drop into both eyes, 4 times daily. allergic conjunctivitis lodoxamide
If ocular symptoms do not respond, consider referral to an optometrist or ophthalmologist. Anti-inflammatory eye drops, including ketorolac and corticosteroids, should only be used to treat allergic conjunctivitis under specialist advice.
Vasoconstrictor eye drops (eg naphazoline, tetryzoline) are not recommended for allergic conjunctivitis. Extended use causes rebound ocular redness, which can in turn lead to overuse.