Ocular allergic represents a
variety of problems that are primarily type-1 hypersensitivity reactions (IgE
mediated) which results in histamine release causing variety of uncomfortablesymptoms and sometime life-threatening complications.
The antiallergic drugs
come in form of topical mass cell stabilizers, topical and oral antihistamines,
topical and systemic NSAIDs, topical steroids and topical immunesuppressors.
Examples of ophthalmic
antiallergic drugs include the following;
CROMOLYN SODIUM (SODIUM CROMOGLYCATE):
It is a topical mast cell stabilizer indicated in the treatment of allergic
ocular disorders including vernal keratitis, allergic keratoconjunctivitis,
giant papillary conjunctivitis and vernal keratoconjunctivitis. It inhibits the
degranulation of sensitized mast cells and basophils which occur after exposure
to specific antigens thus inhibiting the release of histamine and SRS-A (Slow
reacting substance of anaphylaxis) from mast cells. Cromolyn sodium is
available as 2% and 4% topical ophthalmic solution and patient is advised to
instill one to two drops four to six times daily at regular intervals till the
desired effect is obtained.
LODOXAMIDE: It is the most potent
topical mast cell inhibitor and it prevents histamine release from mast cells
during immediate hypersensitivity reactions. Lodoxamide is highly effective in
treatment of vernal and atopic keratoconjunctivitis (VKC and AKC) and in giant
papillary conjunctivitis. It is available as 0.1% ophthalmic suspension with
usual dose of one to two drops four times daily throughout the year.
NEDOCROMIL: It is effective in
VKC, SAC and GPC. Nedocromal prevents chemotaxic and inflammatory mediator
release from mast cells, monocytes, macrophages and granulocytes. It is
available as 1% ophthalmic solution and patient is advised to instill one to
two drops four times daily.
KETOTIFEN: It is indicated for
the treatment of allergic conjunctivitis of diverse etiology. Ketotifen is
available as 0.025% topical solution in 5ml and 7ml packs. Instill one drop
every 8-12 hours.
OLPATADINE (PATANOL): Olopatadine
hydrochloride has both mast cell stabilization effect and an antihistaminic
effect. It is indicated for the treatment of allergic conjunctivitis of diverse
etiology Olopatadine is available as 0.1% ophthalmic solution in 5ml vial. The
patient is advised to instill one to two drops three to four times daily every
six to eight hours.
LEVOCABASTINE (LIVOSTIN):
Levocabastine hydrochloride is indicated in treatment of seasonal allergic
conjunctivitis. It provides relief within minutes and block histamine, the
primary mediatory response to allergy. It is available as 0.05% ophthalmic
suspension. For dosage, instill one drop four times daily, treatment may be
continued up to two weeks.
EMEDASTINE DIFUMARATE (EMADINE):
It is an antihistamine indicated in the treatment of allergic conjunctivitis.
It is available as 0.05% ophthalmic solution. Recommended dosage is to instill
one drop four times daily.
NAPHAZOLINE HYDROCHLORIDE: It
acts as a decongestant used as topical vasoconstrictor to soothe, refresh,
moisturize and remove redness due to mild ocular allergic disorders in minor
eye irritation. Naphazoline is available as 0.012-0.1% ophthalmic solution.
Usual dosage is to instill one to two drops every two to four hours.
TOPICAL NSAIDS: the two common
examples of topical NSAIDs used in eye allergic conditions are; Suprofen and
Ketorolac. They are effective in managing the signs and symptoms of giant
papillary conjunctivitis and vernal kreatoconjunctivitis. Usual dosage is to
instill one to two drops three times daily for four to six weeks.
TOPICAL STEROIDS: Common examples
include; Loteprednol 0.5% solution, Rimexolone 1.0% solution and
Fluorometholone 0.3% solution. They effectively suppresses inflammation in
allergic conjunctivitis. Usual dosage is to instill one to two drops three to
four times daily.
TOPICAL IMMUNOSUPPRESSORS: The
common example is cyclosporine which is available as 2.0% ophthalmic solution
and recommended dosage is to instill one drop four times daily.
ORAL ANTIHISTAMINE: Common
examples are Levocetrizine (5mg tablet), Desloratadine (5mg tablet) and
Fexofenadine (60 and 12mg tablet). Levocetrizine and Desloratadine are
indicated in allergic conjunctivitis and the recommended dosage is to take 5mg
oral tablet once daily. Fexofenadine is indicated in vernal
keratoconjunctivitis and seasonal allergic conjunctivitis. Recommended dosage
is 60mg twice daily or 120mg once daily for fourteen to twenty one days till
desired response is obtained.
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