Allergic conjunctivitis, treatment

In moderate to severe cases of allergic conjunctivitis, treatment considerations also include mast cell stabilizers, antihistamine-mast cell stabilizer combinations, oral antihistamines, NSAIDs, and, in severe cases, topical steroids. 

Use a step-care approach for treatment of allergic conjunctivitis. 

Hj antihistamines are clinically used in the treatment of histamine-mediated allergic conditions. Specifically, these indications may include allergic rhinitis, allergic conjunctivitis, allergic dermatological conditions (contact dermatitis), pruritus (atopic dermatitis, insect... 

Inflammatory conditions Treatment of steroid-responsive inflammatory conditions of the palpebral and bulbar conjunctiva, lid, sclera, cornea, and anterior segment of the globe, such as Allergic conjunctivitis acne rosacea superficial punctate keratitis herpes zoster keratitis iritis cyclitis and selected infective conjunctivitis (when the inherent hazard of steroid use is accepted to obtain an advisable diminution in edema and inflammation [prednisolone]) vernal conjunctivitis episcleritis epinephrine sensitivity and anterior uveitis. 

S. J. Dell, D. G. Shulman, G. M. Lowry, and J. Howes, A controlled evaluation of the efficacy and safety of loteprednol etabonate in the prophylactic treatment of seasonal allergic conjunctivitis, Am. J. Ophthalmol. 123 191 (1997). 

Ketorolac This drug acts like the other NSAIDs. In addition to the oral route, ketorolac [key TOE row lak] can be administered intramuscularly in the treatment of postoperative pain, and topically for allergic conjunctivitis. Ketorolac undergoes hepatic metabolism the drug and its metabolites are eliminated via the urine. It causes the same side effects as the other NSAIDs. 

Cromolyn sodium has been found to be effective in treating the signs and symptoms of allergic conjunctivitis, VKC, and GPC. Patients may obtain relief within 7 days of initiation of therapy. In cases of GPC, clinical evidence of reduction in size of papillae of the upper tarsal conjunctiva may be seen after 3 weeks of treatment. 

Various nonsteroidal anti-inflammatory drugs (NSAIDs) have been studied for potential clinical use in allergic conjunctivitis. Specifically, ketorolac tromethamine 0.5% has been found to be beneficial in treating SAC and is currently the only NSAID approved for topical treatment of SAC. 

Ilyas H, Slonim CB, Braswell GR, et al. Long-term safety of loteprednol etabonate 0.2% in the treatment of seasonal and perennial allergic conjunctivitis. Eye Contact Lens 2004 30 ... 

Kidd M, McKenzie SH, Steven I, et al. Efficacy and safety of keto-tifen eye drops in the treatment of seasonal allergic conjunctivitis. Br J Ophthalmol 2003 87 1206-1211. 

Leino M, Jaanio E, KoivunenT, et al.A multicenter double-blind group comparative smdy of 2% nedocronfil sodium eye drops (Tilavist) with placebo eye drops in the treatment of seasonal allergic conjunctivitis.AnnAUergy 1990 64 398-402. 

Leino M, Montan P, Nja F. A double-blind group comparative smdy of ophthalmic sodium cromoglycate, 2% four times daily and 4% twice daily in the treatment of seasonal allergic conjunctivitis. Allergy 1994 49 147-151. 

Melamed J, Schwartz RH, Hirsh SR, et al. Evaluation of nedocronul sodium 2% ophthalmic solution for treatment of seasonal allergic conjunctivitis. Ann Allergy 1994 73 57-64. 

Mfiler J, Wolf EM. Antazoline phosphate and naphazoUne hydrochloride, singly and in combination for the treatment of allergic conjunctivitis. A controlled double-blind clinical trial. Ann Allergy 1975 35 81-86. 

Tinkehnan DG, Rupp G, Kaufman H, et al. Double-masked, paired-comparison clinical study of ketorolac tromethamine 0.5% ophthalmic solution compared with placebo eyedrops in the treatment of seasonal allergic conjunctivitis. Surv Ophthalmol 1993 38 133-140. 

Underlying ocular disease, such as allergic conjunctivitis, chronic infectious or inflammatory disease, or contact lens-related disorders, should be properly managed either before or as an adjimct to treatment of lacrimal... 

Mast cell stabilizers are an effective and safe treatment modality for allergic conjunctivitis. They are useful in patients who have perennial allergic conjunctivitis and as a prophylaxis fc>r seasonal allergic conjunctivitis. Mast cell stabilizers are effective only when used before the onset of allergic symptoms, because most drugs in this class have a typical therapeutic effect that occurs in 7 days to 14 days. Because there is a delay in noticeable clinical improvement with most mast cell stabilizers, concurrent therapy with other agents may be necessary for immediate relief. Nedocromil is an exception in this category, because it provides a more rapid relief of symptoms, usually within 15 to 30 minutes. 

Mast cell stabilizers include cromolyn sodium 4% (Opticrom, Crolom) and lodoxamide tromethamine 0.1% (Alomide), which are currently approved by the U.S. Food and Drug Administration for VKC but offer off-label relief for allergic conjunctivitis. Other mast cell stabilizers include pemirolast (Alamast) and nedocromil sodium 2% (Alocril), with both approved for treatment of itching in allergic conjunctivitis. Perennial allergic conjunctivitis may be treated with mast cell stabilizers year round. 

Other treatment options include the use of topical NSAIDs, which provide relief of itching. Ketorolac tromethamine (Acular) is the only NSAID approved for the treatment of seasonal allergic conjunctivitis, with symptomatic relief occurring within 30 minutes after administration.Topical NSAIDs are not typically the treatment option chosen, because the other classes of drugs provide better well-established relief. 

A hquid form is also available for use in rhinitis and ocular conditions. When applied topically to the eye cromoghcate is effective in the treatment of vernal keratoconjunctivitis (vernal catarrh, spring catarrh), allergic conjunctivitis, and hay fever. 

Clinical studies proved that it is a safe and effective treatment for contact lens-associated giant papillary conjunctivitis (GPC), seasonal allergic conjunctivitis, postoperative inflammation, or uveitis (101, 102). Based on promising results from animal studies (112-114), loteprednol etabonate is also being developed for treatment of asthma, rhinitis, colitis, and dermatological problems. 

The first example of novel packaging design approaches is a multidose eye-drop pack containing an aqueous solution of a drug used for the treatment of allergic conjunctivitis. The drug is a polar, ionic compound, available as the sodium salt, which is highly water-soluble and has a low lipophilicity. Formulation details are as follows ... 

---