Case Study: Allergic Conjunctivitis

Q: DM is a 48-year-old woman who is looking for something to treat her allergies. She takes loratadine 10 mg daily but wants to also try eye drops. DM says she has had allergies for years and that they have gotten worse over the past few weeks. A few years ago, her physician tested her for allergies and found that she is allergic to pollen. DM loves being outdoors and hikes often. Typically, loratadine relieves her symptoms. However, when DM has been outdoors recently, her eyes have gotten very itchy and red. She spoke to her doctor, who said she could get some allergy drops over the counter. DM has no other medical conditions and does not take any other medications. What recommendations do you have?

A: As mentioned in the earlier case, trigger avoidance is key. Although DM enjoys the outdoors, she can try turning on the air-conditioning when she is driving or indoors to avoid additional pollen exposure. She can also try using protective equipment or sunglasses to prevent pollen from getting into her eyes. Advise DM to continue taking loratadine. She can also use eye drops for symptom relief. Although ophthalmic antihistamines are available, the first-line treatment for allergic conjunctivitis is artificial tears. Artificial tears can wash out the pollen from DM’s eyes. The typical manufacturer recommendation is 1 to 2 drops as needed, depending on the product she purchases.1 If artificial tears do not work or symptoms persist, DM can switch to an ophthalmic antihistamine. Ketotifen fumarate 0.025% is now available over the counter to treat allergic conjunctivitis. Brand names include Alaway and Zaditor. They are recommended for use twice daily and are safe for those 3 years and older. If DM tries an ophthalmic antihistamine, she should see a physician if her symptoms do not resolve after 72 hours of appropriate treatment.2

View additional pharmacist-recommended OTC products at OTCguide.net.

References
  1. Systane Ultra Eye Drops ingredients and usage. Systane website. systane.com/product-ingredients/systane-ultra-lubricating-eye-drops/. Accessed April 13, 2019.
  2. Systane Zaditor Antihistamine Eye Drops. Systane website. zaditor.com/antihistamine-eye-drops.shtml. Accessed April 13, 2019.