Allergic Conjunctivitis
Inflamed conjunctiva and lids as part of reaction to systemic allergen (usually pollens or grasses) Usually peaks in Spring or Fall Often accompanied by upper respiratory tract symptoms, but may be most bothersome—or only—manifestation
Itchy eyes—usually both of them Swollen lids Diffusely red (hyperemic) conjunctivaMild watery—sometimes mucoid—discharge Preserved vision Often upper respiratory allergic manifestations
Prescribe systemic antihistamines If they do not work, prescribe from these topical choices: Vasoconstrictors: inexpensive over-the counter agents include antazoline phosphate 0.05%, naphazoline HCl 0.05%, oxymetazoline HCl, tetrahydrozoline HCl 0.05%, and phenylephrine 0.12% H-1 receptor antagonists: more effective than vasoconstrictors, but more expensive include pheniramine maleate 0.3% (Naphcon), emedastine (Emadine), and levocabastine HCl 0.05% (Livostin) Nonsteroidal anti-inflammatory agents: used in combination with other topical agents include ketorolac tromethamine 0.5% (Acular) and ketotifen 0.025% (Zaditor) Mast cell stabilizers: include cromolyn sodium 4% (Crolom), nedocromil 2% (Alocril), pemilorast 0.1% (Alamast), and lodoxamide tromethamine 0.1% (Alomide) Combined H-1 receptor antagonist and mast cell stabilizers more effective than mast cell stabilizers alone include olopatadine hydrochloride 0.1% (Patanol), optivar, and elestan
Systemic medications do not always eliminate symptoms adequately Topical medications, with or without systemic medications, usually provide adequate relief; if not, condition particularly fierce or diagnosis wrong, so refer to ophthalmologist Symptoms usually decrease spontaneously when allergen level falls
