Allergic Conjunctivitis
This is my bad time of the year for ocular allergy. For most people its spring, but for me its Sept-Oct-Nov-Dec. I don't know what I'm allergic to but whatever it is, its out in those fall months. I get the nasal congestion, etc but worst of all is the ITCHY THROAT (palate) and itchy/watery eyes. My eyes are also very gooey/sticky in the mornings (mucous). I know, TMI right?
I just wanted to discuss what personally works for me b/c I'm using Rx antihistamines daily right now. Here's what I use myself and what I Rx for patients and why:
1) Bepreve: I really like this drug and its recently been one of my "go-to" Rx antihistamines. It clears the "goo" quickly, stops the itch & even helps with the itchy throat (palate), no kidding. This stuff really works. It has a pretty bad aftertaste, tho...which I personally do not mind at all, but patients (and my wife) absolutely detest. So that's a downer. To be used twice a day.
2) Lastacaft: This stuff works really well too and has zero aftertaste. This is what my wife uses (a GPC sufferer, since I blog about GPC a lot). I don't think it helps with the itchy palate, so for that reason I still like Bepreve a little better for my own use. But for the actual ocular symptoms that most of you are asking the O.D. about, this one is as good as you can get. Plus my wife & daughter both greatly prefer this one b/c it has no sting & no aftertaste. 12/14/2011 edit: I just found out this is ONCE a day (QD) not twice a day (BID!) I can't believe I didn't know that! I mistakenly thought it was BID. Oops. Hey I can admit when I am wrong! My excellent Allergan rep corrected me.
3) Pataday (olopatadine 0.2%): Also a great drug. Designed for once-a-day dosing, this is the successor of the wildly successful "Patanol" (which was twice-a-day). I'm not sure I ever bought the idea that simply doubling the concentration of Patanol (olopatadine 0.1%) lengthened the effectiveness of the drug another 8 hrs, but I guess it's possible. This is probably the most-Rx'd eye drop right now (edit: Allergan rep says the most Rx'd drops are XALATAN & RESTASIS). Very popular.
4) There's one OTC antihistamine that I think works pretty well, and it's not Visine-A, Opcon-A nor Clear Eyes-ACR, as all of those are mainly vasoconstrictors with old, not very effective antihistamines. Over the counter I like ketoifen fumarate, which is sold under at least 4 (and probably more) brand names: Alaway, Zaditor, Wal-Zyr (Walgreens brand Eye Itch Relief), and Zyrtec Itchy Eye Drops. This drug works better (IMO) than any other OTC anti-allergy eye drop, and almost as well as the Rx ones above, at a fraction of the cost.
5) When the patient has significant redness, swelling or inflammatory signs beyond just the symptoms of itch & mucous production, I typically get more aggressive & Rx steroids. My steroid of choice for this is Bausch & Lomb's Alrex. This stuff is very safe, even for long term usage, and eliminates itch as well as swelling, redness & inflammation. The only downsides are the sometimes-overhyped stigma of steroid usage (glaucoma, cataracts, etc), and the fact that usually steroids don't INSTANTLY eliminate the itch, like the antihistamines above do.
I just wanted to discuss what personally works for me b/c I'm using Rx antihistamines daily right now. Here's what I use myself and what I Rx for patients and why:
1) Bepreve: I really like this drug and its recently been one of my "go-to" Rx antihistamines. It clears the "goo" quickly, stops the itch & even helps with the itchy throat (palate), no kidding. This stuff really works. It has a pretty bad aftertaste, tho...which I personally do not mind at all, but patients (and my wife) absolutely detest. So that's a downer. To be used twice a day.
2) Lastacaft: This stuff works really well too and has zero aftertaste. This is what my wife uses (a GPC sufferer, since I blog about GPC a lot). I don't think it helps with the itchy palate, so for that reason I still like Bepreve a little better for my own use. But for the actual ocular symptoms that most of you are asking the O.D. about, this one is as good as you can get. Plus my wife & daughter both greatly prefer this one b/c it has no sting & no aftertaste. 12/14/2011 edit: I just found out this is ONCE a day (QD) not twice a day (BID!) I can't believe I didn't know that! I mistakenly thought it was BID. Oops. Hey I can admit when I am wrong! My excellent Allergan rep corrected me.
3) Pataday (olopatadine 0.2%): Also a great drug. Designed for once-a-day dosing, this is the successor of the wildly successful "Patanol" (which was twice-a-day). I'm not sure I ever bought the idea that simply doubling the concentration of Patanol (olopatadine 0.1%) lengthened the effectiveness of the drug another 8 hrs, but I guess it's possible. This is probably the most-Rx'd eye drop right now (edit: Allergan rep says the most Rx'd drops are XALATAN & RESTASIS). Very popular.
4) There's one OTC antihistamine that I think works pretty well, and it's not Visine-A, Opcon-A nor Clear Eyes-ACR, as all of those are mainly vasoconstrictors with old, not very effective antihistamines. Over the counter I like ketoifen fumarate, which is sold under at least 4 (and probably more) brand names: Alaway, Zaditor, Wal-Zyr (Walgreens brand Eye Itch Relief), and Zyrtec Itchy Eye Drops. This drug works better (IMO) than any other OTC anti-allergy eye drop, and almost as well as the Rx ones above, at a fraction of the cost.
5) When the patient has significant redness, swelling or inflammatory signs beyond just the symptoms of itch & mucous production, I typically get more aggressive & Rx steroids. My steroid of choice for this is Bausch & Lomb's Alrex. This stuff is very safe, even for long term usage, and eliminates itch as well as swelling, redness & inflammation. The only downsides are the sometimes-overhyped stigma of steroid usage (glaucoma, cataracts, etc), and the fact that usually steroids don't INSTANTLY eliminate the itch, like the antihistamines above do.
Bepreve is the only thing that has worked for me. My insurance (BCBS) only covers a very small portion of it though. Why is that? you'd think if it works so well the insurance company would pick it ut. Anyway... So I always end up using samples and never getting to buy the Rx.
ReplyDeletehaha well basically b/c insurance companies don't like to pay. when they "cover" a medication it's b/c they have worked out a deal with the manufact. to get it CHEAP. when they "don't cover" a medication it's b/c they can't or haven't reached a deal with the manufact. yes it really is that simple. if it's not CHEAP for the insurance company, they ain't gonna pay.
ReplyDeleteI read on Bepreve's website that it isn't supposed to sting the eye when a drop of it is applied to the eye. However, when I put a drop in, it stings like crazy for a good minute. It has me tearing up and in a great deal of discomfort. I don't plan on using it anymore until I talk to my eye doctor but could you tell me if this means something? Thanks
DeleteIt doesn't mean very much. It's not really diagnostic of anything if that's what you're asking. Burning/stinging is far & away the #1 reported side effect of every eye drop, no matter what the manufacturer says. I always say if it stings that badly, don't use it. There are plenty of antihistamines out there to try - ask your doc for a different one. Good luck!
ReplyDeleteI posted a question in the Yahoo! Answers site about my dry eyes. You recommended I give Omega 3 Fish Oil a try (thanks by the way). Do you have a suggestion for one that produces the best results? Is "Tears Again HYDRATE™ Nutritional Supplement for Dry Eyes" better because it's prescription?
Deleteit's debatable whether tears again hydrate is better or not. IMO...it's probably not better than some OTC products. just my opinion
ReplyDeleteI would be flattened if all websites gave articles like that.
ReplyDeletecan-c
Great article, thanks!
ReplyDeleteMy eyes are so dry they burn all the time I have tried every drop out there.. My Dr. has me on restasis with everything refresh has for contacts the day drops night drops. I spend so much money i am so discouraged I try so hard to wear my contacts as soon as I put them on my eyes i gets a film build up.. I hate glasses because I work out a lot and I loss them.. I have also tried all those prescriptions Lastacaft, Patanol,l Bepreve. Please give me your opinion need help!!! Also if she would just tell me she can't help me instead I just keep coming back no improvement is there anything that can be done?
ReplyDeletewell, "DRY" is different than "allergies". lastacaft, bepreve and patanol are not going to help with "dryness". and having dry contacts...that's the #1 complaint in all of the contact lens world. there is nothing to do but try Restasis, try different brands and materials (have you tried dailies?) and try different anti-dryness eye drops.
DeleteLast week, I woke up one morning with an annoying sensation in my left eye. The feeling persisted for two days; I felt like a foreign substance was stuck in my eye. This would only happen when I would close my eyes. I finally went to see an ophthalmologist. After the exam, I was diagnosed with Acute Allergic Conjunctivitis. My eyes are not dry, red, swollen, itchy, watery, nor do I wake up with watery discharge crusted around my eyes in the morning. I only feel this annoying sensation in my left eye. I was prescribed Pataday, and another eye drop for reducing the inflammation of the swollen papillae on the inside of my eyelids, which are more present in my left eye. I have just begun my second day of treatment, and I still feel that annoying sensation when I close my eyes to sleep at night. How long does it usually take for a condition like mine to heal? I am quite concerned about this.
ReplyDelete