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Treatment of Allergic Conjunctivitis
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Aside from identifying and subsequently avoiding offending allergens, symptom control is the most practical method of providing relief to seasonal allergy sufferers. Use of cold compresses and irrigation with saline solution or artificial tears may all help to relieve mild symptoms, but for severe or persistent symptoms, medication may be necessary.
All therapeutic agents that address symptoms of seasonal allergy sufferers act on chemical mediators involved in the immune response. They fall into one of four classes:
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- Antihistamines
- Mast cell stabilizers
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Corticosteroids
Antihistamines (H1-receptor antagonists)
Antihistamines (H1-receptor antagonists) are among the most frequent initial therapeutic approaches employed because histamine is one of the main chemical mediators that triggers symptoms of ocular allergy. Ophthalmic formulations are targeted directly to the involved site and usually provide rapid symptom relief without significant systemic side effects. Combinations of topical antihistamines with a topical vasoconstrictor may also be useful in short-term treatment of mild allergic conjunctivitis. Orally ingested antihistamines may partially relieve ocular symptoms and may be effective on nasal symptoms. However, topical eye drops may be fastest and most effective in relieving ocular itch, redness, and swelling. Unlike oral medications, eye drops allow the medication to get directly to the affected eyes.
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Mast Cell Stabilizers
Mast cell stabilizers have a slow onset of action, and may require several days of treatment before optimal symptom relief is achieved. They may therefore be more suitable for prophylactic and long-term treatment of chronic ocular allergies than for immediate symptom relief in acute seasonal conditions.
Dual- or Multiple-Action Agents
Dual- or multiple-action agents have been introduced in some markets in recent years. Dual-action agents combine the actions of antihistamines with those of mast cell stabilizers. These agents diminish the effects of both preformed mediators of inflammation and newly formed mediators via mast cell stabilizing activity and antagonism of histamine receptors. They provide effective relief from acute symptoms of the early-phase allergic reaction and inhibit the inflammatory processes triggered by the late-phase response. Multiple action agents also inhibit eosinophil infiltration at the site of the allergic reaction. These agents act on both the early- and the late-phase allergic response.
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Topical NSAIDs
Topical NSAIDs do not alleviate all signs and symptoms associated with seasonal allergic conjunctivitis.
Corticosteroids
Corticosteroids are effective, but long-term use is associated with deleterious and well-known side effects (delay in corneal epithelium healing, local immunosuppression with consequent superinfection of cornea and conjunctiva, rise in intra-ocular pressure, and cataract formation).
Allergen Desensitization
Allergen desensitization therapy may be indicated in selected cases. The risk of anaphylaxis and other adverse reactions related to immunotherapy limits its use to specialists experienced in administering this kind of therapy.
For More Information
For more information about treatment options, click here.
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