Ocular Allergies: Guide to Prescription Drops

Over the counter drops not relieving your itching, watering, redness, and swelling? A prescription strength drop is much more effective at knocking out moderate to severe allergies.  For contact lens wearers, OTC drops and their frequent dosing schedules are just not practical.  A once daily prescription strength drop will be much more effective for these patients, and less disruptive of their daily routines.  Here's a breakdown of the available ophthalmic drops; how often to dose them, and what, if any, side effects to expect.


TOP OF THE LINE ANTI-HISTAMINES
PATADAY: Fast relief, good medical coverage so the copay tends to be reasonable
Dosage: 1 x Day
Side Effects: None commonly reported.  Do not use on top of contact lenses.
Also available is the weaker concentration Patanol, that is dosed 2 x daily instead of once daily.


LASTACAFT: Fast relief, studies show that patient's get relief within 5-10 minutes of dosing
Dosage: 1 x Day
Side Effects: None commonly reported.  Do not use on top of contact lenses.


BEPREVE: Fast relief, can also give some minor nasal symptom relief as it drains down the back of your throat from the eye.
Dosage: 2 x Day
Side Effects: Can have a metallic after taste in some patients.
This drop comes in a much larger bottle than the prior 2, so it offers some financial advantage.  For milder symptoms, it can be used just once daily.



GENERIC ANTI-HISTAMINES: Prescription strength, but budget friendly.  These are older drops that are still effective, but need more frequent dosing than above.

EPINASTINE HCL: Also known as ELESTAT
Dosage: 2 x Day

AZELASTINE: Also known as OPTIVAR
Dosage: 2 x Day


SOFT STEROIDS: For patients suffering from severe allergic reactions with marked chemosis (swelling), you can't beat a steroid.  This is really effective for patients with a contact lens induced allergy like Giant Papillary Conjunctivitis.

If the eyelids look like this, you might want to use a steroid for faster resolution of this follicular reaction

ALREX: Loteprednol 0.2%
Dosage: Anywhere from four to once daily.  I typically dose twice daily unless the allergy reaction is very severe and I think four times a day is necessary.
Instructions:  SHAKE WELL.  This is a suspension, so you need to shake several times to adequately mix the medication into solution.
I typically keep patients on this drop for 2 weeks to 1 month, but in lower doses it is safe for longer term use.

FML or LOTEMAX OINTMENT: 
Dosage: 1 to 2 times daily
Lotemax has a higher safety profile, but FML ointment is still a low strength steroid.  Neither are generic, and an FML ointment Rx can have a copay as high as $60.  For really chronic follicular reactions, the contact time of an ointment can truly make a difference.  Obviously, like all the drops listed in this post, do not insert when wearing contact lenses.