Treatment

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The treatment of ocular allergies is based largely on the degree to which symptoms interfere with quality of life. The more severe the symptoms, the more likely they are to interfere with everyday activities. The first step is to simply avoid or remove the allergens that are creating the problem. Some people find that applying cold compresses to the eyes is very soothing. That's because the compresses cause vasoconstriction, or a reduction of inflammation in the eye's blood vessels. Artificial tears, cooled by storing in a refrigerator, might produce similar results. It may also be necessary to avoid wearing contact lenses. Treating any associated eyelid problems, such as rashes or eczema, with lid scrubs and topical antibiotics may also help.

It may be necessary to get symptoms under control quickly by using a more aggressive approach. Following is a list of medications that are sometimes used.

Over-the-Counter Medications:

Artificial tears are extremely safe and can be used at any age. The use of lubricants or saline washes helps to remove allergens from the eye's surface to relieve mild symptoms. However, artificial tears contain no pharmacologically active ingredients to specifically combat the allergic reaction. Instead, these products mimic the soothing properties of natural tears and provide fast relief. If your eyes are especially sensitive, you might consider using preservative-free products, which may be helpful for patients complaining of both allergy and dry eye symptoms or "itchy, burny" eyes.

Over-the-counter eye drops, which frequently contain decongestants and antihistamines, are used by many people for short-term relief of some symptoms. They also help to reduce redness by constricting conjunctival blood vessels. However, they may not relieve other symptoms. Another shortcoming is that some may only be used for short periods of time, no more than four times a day for no more than two weeks. Prolonged use may make your symptoms worse, causing more swelling and redness that persists even after you stop using the drops. Tachyphylaxis, or a rebound effect, sometimes occurs with the use of other decongestants as well, such as nasal sprays. Although initially they seem to relieve stuffiness, after a few days your nose feels stuffier than ever. It's especially important to note that if you have heart disease, arteriosclerosis, or narrow angle glaucoma, some eyedrops may pose a danger to your health. Your health care professional can tell if the solutions you are using might jeopardize your health or worsen your condition.

Over-the-counter oral antihistamines, available in both liquid and pill forms, can relieve itching slightly, but at the same time may cause dry eyes, worsening eye allergy symptoms. Side effects are sometimes very unpleasant and can include drowsiness, agitation, dizziness or poor coordination. These should not be used as primary therapy for ocular allergy. Direct, topically applied ophthalmic medication is a much better treatment. If you're taking over-the-counter oral antihistamines for nasal symptoms, consider adding an eyedrop to adequately address eye ocular complaints. An eyedrop can aid in treatment of nasal symptoms as well via medication drainage to the nose or preventing allergic mediators from being released in the eye, thus preventing their drainage to the nose.

Prescription Medications

Antihistamines are available in both oral and topical forms. Topical antihistamines come in the form of eyedrops and are sometimes preferred over oral forms as they are applied directly to the eye and act more rapidly. Eyedrops are less likely to cause side effects because they are not taken into the body systemically as oral medicines are. Antihistamines provide quick relief, but sometimes only for a few hours. Some of the oral prescriptions are formulated to be non-sedating and so do not cause the drowsiness of over-the-counter formulations, but they still can cause some drying effect on the eyes, contributing to or worsening symptoms of dry eyes. Some of the topical antihistamines need to be reapplied four times a day. They last about two hours, but shouldn't be taken more than four times a day, so it could be difficult to get daylong coverage for your allergies if you're relying solely on an ophthalmic antihistamines.

Combination mast cell stabilizers and antihistamines are the most recently developed drugs of those available for topical ophthalmic treatment of allergic conjunctivitis. They combine the mechanisms of both an antihistamine and a mast cell stabilizer in a single drug. This allows for rapid blocking of the histamine receptors on nerves and blood vessels that are the cause of the itching and redness of allergy, as well as stabilizing the mast cells to prevent further release of substances/molecules that would induce further allergic reaction. Dosing ranges from one to four times a day. Drugs in this class include olopatadine (Pataday, Patanol), azelastine HCl (Optivar), and nedocromil (Alocril).

Second-generation mast cell stabilizers work to prevent those cells from releasing the substances responsible for itching and, if chosen as allergy therapy, must be used regularly to prevent problems in people with seasonal allergic conjunctivitis. Used four times a day, they provide fast and long-lasting relief from allergic eye symptoms. Mast cell stabilizers are not thought of as the fastest acting of the choices for allergic conjunctivitis. In fact, it usually takes two weeks before they reach their peak effectiveness. Plus, the four-times-a-day dosing makes these drugs less practical than drugs with dosages of twice a day. Additionally, they require regular, consistent dosing throughout the allergy season, not just when an acute attack occurs.

Corticosteroids tend to be prescribed carefully, using the minimum dose and mildest type of steroid for the shortest possible time. One topical corticosteroid, loteprednol etabonate (Alrex, Lotemax), is prescribed when a rapid response to treatment is necessary and other drugs have not worked. Corticosteroids should never be used for any length of time, as they have been linked to cataracts, glaucoma and superinfections of the eye's surface.

Allergy shots, or immunotherapy, are sometimes used when other therapies do not help control your symptoms. These shots inject increasing amounts of the allergens that are affecting your eyes into your body to help curb your eyes' reaction. The treatment usually takes several months to achieve maximum results.

Selecting the Proper Treatment

Your health care professional will recommend or prescribe the medication needed to treat the symptoms that are most troublesome to you. The most common and most effective medications used to treat ocular allergies are topical—that is, they are applied as eyedrops directly to the surface of the eye. Topical medications offer several advantages in that they are noninvasive and deliver medication directly to the part of your body where it is needed most—your eyes—where it can be speedily absorbed. This also reduces the risk of side effects within other parts of your body because the drug is not absorbed throughout your system the way an oral drug would be. The effect of a topical eye drop depends on several factors, including the size of the drop, the size and condition of the eye and your willingness to consistently use it as directed.

Some medications are safe for children but others are not, so be sure to read the packaging information carefully before offering your children any type of medication. Medication available by prescription should, of course, be used only by the individual to whom it was prescribed and not shared with any others.

Your health care professional may recommend more than one medication for you. In that case, be sure to administer eyedrops or ointments at least five minutes apart to allow enough time for your eyes to absorb each medication and to prevent one drug from diluting the other. In addition, contact lens wearers should carefully follow instructions regarding medication instillation prior to lens insertion, typically a 15-minute wait between medication and lens insertion. If you are using a solution and an ointment, use the solution first, followed by the ointment, since an ointment can prevent the drops from entering the eye.