Diagnosis
-H&P: Pt endorses itching, tearing, swollen eyelids, redness. Bilaterally. Often associated with allergic rhinitis.
-Avoid allergens/precipitants when possible.
-Don’t wear contact lenses while symptomatic.
-Artificial tears PRN.
-Topical antihistamines and mast cell stabilizers, alone or in combination are effective. Will Rx Ketotifen ophthalmic (Zatidor) 1 gtt BID until symptoms resolve. Ketotifen is both an antihistamine and a mast cell stabilizer. Available OTC without prescription. Another option we could consider will be epinastine ophthalmic BID. It is an antihistamine and is more expensive than ketotifen.
–Allergen testing (Labcorp zone 13 in California).
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**Zaditor is OTC and so patients can buy it.
I’ve seen a doctor (Dr. Sweet) in our clinic use the following combination on a patient with allergic conjunctivitis:
-Allergy eye (Naphazoline-pheniramine) 0.025% 0.3% drops. 2 gtt OU TID to QID prn pruritis. Disp: 1 bottle; Ref: 3
-Patanol (Olopatadine) 0.1% eyedrops. 1 gtt two times daily at intervals 6-8 hours. Disp: 1 bottle. Ref: 3
-Loratadine-D (Loratadine/Pseudoephedrine) 10mg – 240mg tab, extended release 24hr. Take 1 tab PO daily. Disp: 60; Ref: 3
Pheniramine is an antihistamine with anticholinergic properties.
Naphazoline is a decongestant. It is a sympathomimetic agent.
Resources:
AFP Journal, June 1, 2016