Page 82 - Community pharmcy practice E-book 2025

02/11/2025, 00:10 Otic & Ophthalmic Disorders | Dermatological Disorders

keeping windows and doors closed, running the home's air conditioning system, using air filters, and so on.

Wearing sunglasses outdoors will shield eyes from the wind and allergens for many patients.

Pharmacologic Therapy

First-line treatment for allergic conjunctivitis is instillation of artificial tears (possibly refrigerated) as needed.
Artificial tears may help wash out the allergens and provide some symptom relief.
If symptoms persist, the patient should switch to OTC ophthalmic product or possibly oral anti-histamine
product.

OTC medications used for treatment of allergic pink eye:

First line Oral anti-histamines.
Second line Ophthalmic antihistamine/mast cell stabilizer combination: ketotifen, Olopatadine.
Second line Ophthalmic decongestants (often in combination with antihistamines)
Medical referral is indicated if symptoms do not resolve after 72 hours of appropriate treatment.

1. Ophthalmologic Antihistamine/Mast Cell Stabilizer

Olopatadine (0.1, 0.2, 0.7%) & Ketotifen fumarate 0.025%.
Dose: twice daily and is very effective in relieving the signs and symptoms of allergic conjunctivitis.
✓ They are very safe and can be used in patients 2 years of age and older.

✓ Both has dual effect as anti-histamines and mast cell stabilizers.

2. Ophthalmic anti-histamines

Two nonprescription antihistamines are available for topical ophthalmic use: pheniramine maleate and
antazoline phosphate.
Although either agent is effective alone, nonprescription products containing these antihistamines also
contain a decongestant.
The two combinations are pheniramine/naphazoline and antazoline/naphazoline.

3. Ophthalmic decongestants (alpha-adrenergic agonist)

Decongestants reduce ocular redness by acting as local vasoconstrictors.
Vasoconstrictors are effective in constricting conjunctival vessels, with consequent reduction in redness,
vascular congestion, and eyelid edema, but they do not diminish the allergic response.
Five nonprescription decongestants are available for topical application to the eye: phenylephrine,
naphazoline (Maximum strength 0.015%; EDA), tetrahydrozoline, oxymetazoline, and brimonidine.

They should not be used for more than 72 hours to avoid Rebound congestion.
The lowest effective concentration and conservative dosage frequencies of ocular decongestants
should be used to avoid eye dryness & rebound redness.
Patients with apparent rebound congestion should be referred to an eye care specialist for further
evaluation and appropriate management.

81