Allergic Conjunctivitis: Cold Compress Helps Other Treatments

Troy Brown, RN

October 01, 2013

Allergic conjunctivitis signs were reduced most effectively by a cold compress (CC) combined with artificial tears (ATs) or epinastine hydrochloride (EH) drops, according to a randomized, masked clinical trial of 18 individuals allergic to grass pollen.

Paramdeep S. Bilkhu, BSc, from the Ophthalmic Research Group, Life and Health Sciences at Aston University in Birmingham, United Kingdom, and colleagues published their findings online September 24 in Ophthalmology.

A total of 18 participants were exposed to grass pollen in an environmental chamber to cause an ocular allergic reaction. They received ATs, CC for 5 minutes, ATs and CC combined, or no treatment randomly at each separate visit. Of those 18 participants, 11 also received either EH drops alone or with CC in random order or the same volume of saline drops. EH is a dual-action antihistamine–mast cell stabilizer.

"In this study, the combination of EH combined with CCs was superior to EH alone in reducing ocular surface temperature (P < 0.001), was superior to EH in reducing hyperemia both nasally (P < 0.001) and temporally (P < 0.001), and enhanced the symptom recovery profile within the first 20 minutes," the authors write.

The main outcome measures were bulbar conjunctival hyperemia, ocular surface temperature, and ocular symptoms; these were measured at baseline and every 10 minutes after treatment for 1 hour.

Symptoms were reduced more by all treatments than no treatment (P < .001), but all nonpharmaceutical treatments failed to return global ocular symptom scores to baseline levels within 1 hour after antigen exposure (no treatment, 58.6% relative return to baseline; CC, 71.6%; ATs, 84.8%; and ATs plus CC, 86.9%; P < .001).

Hyperemia was reduced more by ATs combined with CC than other treatments (P < .05). No treatment reduced hyperemia to baseline levels within 60 minutes (no treatment, 16.5% relative return to baseline; CC, 57.9%; ATs, 73.3%; and ATs plus CC, 76.5%; P < .001), but they all improved hyperemia both nasally and temporally significantly more compared with no treatment (P < .05).

Temporal bulbar conjunctival and corneal temperatures were lowered to baseline levels by CCs (within 50 minutes), ATs (within 40 minutes), and ATs combined with CCs (within 40 minutes). Nasal bulbar conjunctival temperatures returned to baseline more quickly (within 40, 30, and 40 minutes, respectively).

Both EH alone and EH combined with CC reduced symptoms more effectively compared with CC or ATs alone or combined (P < .01).

Artificial tears combined with CCs reduced hyperemia more effectively than ATs, CCs, and EH alone, and EH combined with CCs nasally. Cold compresses enhanced the treatment effect of EH.

Cold compresses combined with either ATs or EH reduced the antigen-raised ocular surface temperature to lower than baseline. Artificial tears alone or combined with a CC or EH reduced the temperature slightly (<0.5°C) but significantly (P< .05). The effect was similar when CC was combined with either ATs or EH.

Coauthor James S. Wolffsohn, PhD, deputy executive dean of the School of Life and Health Sciences and member of the Ophthalmic Research Group at Aston University in Birmingham, United Kingdom, commented on the study in an email interview with Medscape Medical News. "We conducted this study after I presented on ocular allergy at a meeting of eye-care professionals and a fellow presenter who was an allergist quite rightly pointed out there was no evidence to support the use of nonpharmaceutical treatments for ocular allergy, such as [CC] and [ATs]," he said.

"As it was a masked, randomized controlled trial and a repeated-measures design, patients could be tested against their own baseline, making the statistical power very high even with the relatively small patient cohort we recruited. Hence, we have every confidence that the data set is sufficient to guide clinical practice," Dr. Wolffsohn explained.

The authors have disclosed no relevant financial relationships.

Ophthalmology. Published online September 24, 2013. Abstract


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.