Mitchell H. Friedlaender

Disclosures

Curr Opin Allergy Clin Immunol. 2011;11(5):477-482. 

In This Article

Treatment

Treatment of ocular allergy is usually tailored to fit the severity of signs and symptoms (see below). Treatment options for ocular allergy includes

  1. avoidance of allergen,

  2. cold compresses,

  3. oral antiallergics,

  4. vasoconstrictor/antihistamine eye drops,

  5. mast cell stabilizers eye drops, and

  6. corticosteroid eye drops.

If symptoms are mild, no treatment is necessary. Many patients tolerate mild itching and redness of the eyes during the allergy season without resorting to medication. If the allergen can be identified, and avoided, allergic symptoms may be mild, or nonexistent. Many patients with ocular allergy use oral antiallergics on a regular basis. The effect of these oral medications may be sufficient to control ocular symptoms. Antiallergic eyedrops may be useful. Over-the-counter preparations containing a vasocontrictor, usually naphazoline hydrochloride, and an H1 antihistamine, usually antazoline, or pheniramine, are readily available. They are especially useful for reducing conjunctival injection. Adverse reactions are extremely rare with these combination drugs. Concern has sometimes been expressed about a 'rebound' vasoconstriction with these drugs. If rebound vasodilatation does occur, it is mild, and harmless. Several mast cell stabilizers are available,[15,16] both over the counter, and by prescription. They are effective for treating the signs and symptoms of mild to moderate allergic conjunctivitis. They also have a high safety profile. These drugs inhibit the release of mast cell mediators. Some have been shown to have antihistaminic properties, and some have antichemotactic effects. Mast cell stabilizers are used once or twice a day. They can be used throughout the allergy season without concern for adverse reactions. For severe allergic conjunctivitis, corticosteroid eye drops are an order of magnitude more potent than mast cell stablilizers.[17,18] Low-dose corticosteroids, particularly those which have little glaucomagenic potential, are preferred. Fluorometholone and loteprednol etabonate are among the preferred corticosteroid eye drops for ocular allergy. Patients receiving corticosteroid eye drops should be monitored for glaucoma and cataracts every 4 months. One should keep in mind that intranasal corticosteroid sprays have been associated with elevated intraocular pressures, and glaucoma damage.[19] There may be some benefit from the use of topical cyclosporine eye drops in the treatment of ocular allergy;[20] however, oral cyclosporine and other antimetabolites have no role in the treatment of ocular allergy.

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