Everything You Need to Know About Allergy Eye Drops

How terrible is that thick layer of yellow pollen coating everything in your home town right now?  In the City of Oaks, let me tell you, it is peak allergy season.  Sneezing, coughing, congestion; itchy, red, and watery eyes.  Luckily, there are so many great allergy eye drop products that your optometrist can prescribe, there is no reason to suffer.  Here's a break down of the best drops on the market, in alphabetic order (I am in no way affiliated with any of these companies):

Alaway or Zaditor

Active Ingredient:  Ketotifen   H1 antihistamine and mast cell stabilizer 

Type:  Over the Counter

Dosage: 2 x a Day

Approved for: Age 3+

Benefits: Very competitive itch relief data, Alaway comes in a larger bottle size so usually I would recommend this to Zaditor.  Of your OTC drops, these are your 2 best options!

Side Effects: Burning upon insertion, possible pupil dilation (it has a vasoconstriction effect)

The Bepreve marketing campaign speaks to its big advantage
over other drops on the market, relief for severe itch!  via

Bepreve

Active Ingredient:   Bepotastine   H1 antihistamine

Type:  Prescription

Dosage: 2 x a Day

Approved for: Age 2+

Benefits: This drops's FDA trial performance was great for patients even with "severe" itch, and results for itch relief are seen just a few minutes after drop insertion.  There is a secondary benefit of action against post-nasal drip in some patients, so this eye drop can help your eye and nasal symptoms at the same time!  It is a very comfortable drop to insert, with little to no stinging. Also it comes in a very large bottle size (up to 10 mL) so you are getting a lot of eye drop for your copay.

Side Effects: 25% of patients experience a metallic after-taste after the drop is inserted.

Lastacaft

I really like Lastacaft for my contact lens wearing
 patients due to its long lasting effects, but it does
sting via

Active Ingredient:  Alcaftadine   H1 antihistamine and mast cell stabilizer

Type:  Prescription

Dosage: 1 x a Day

Approved for: Age 2+, and Pregnancy Category B (which means, if needed this would be safer to use than other drops on the market)

Benefits: Again, excellent itch relief within just a few minutes.  Great with contact lens wearers that don't want to be bothered by putting drops in more than 1 x a day.

Side Effects: Burning upon insertion, possible redness after insertion.  Other draw backs besides relatively poor insertion comfort is a small bottle size (only 2.5 mL)

Pataday

Active Ingredient:  Olopatadine   mast cell stabilizer

Type:  Prescription

Dosage: 1 x a Day

Approved for: Age 2+, and Pregnancy Category C

Benefits: Typically really good insurance coverage since this drop has been on the market for a while. Good comfort with insertion.

Side Effects: Runny nose/cold symptoms reported in 10%.  Other draw backs: small bottle size (only 2.5 mL), and studies show Pataday and the older Patanol (which is 2 x a day dosed) perform almost equally in itch relief.  What does this mean to you?  If you have bad enough symptoms, you will likely be needing this drop 2 x a day instead.

One thing I didn't mention because in the world of optometry, we have been hesitant to include steroids in our allergy arsenal.  But for the right patient, I think Alrex (which is approved for seasonal allergies by the way) is your very best choice:

Alrex

Giant Papillary Conjunctivitis; your doctor
looks underneath your eyelids to find
 the tell-tale sign for this condition

Active Ingredient:  Loteprednol   ester based steroid (soft steroid)

Type:  Prescription

Dosage: up to 4 x a day, SHAKE before using

Approved for: No age minimum has been set, but the youngest study participant was 10. Age is up to doctor's discretion.
Pregnancy Category C

Benefits: All of the antihistamine drops listed above just treat the symptoms, but Alrex (and steroids for that matter) actually treat the culprit -- inflammation.  That means it works for swelling, redness, watering, puffy eyelids.  You name it.  A steroid is the only way to truly knock out an allergic response, and that is why allergists use them almost exclusively.  If you have a major ocular allergic condition like giant papillary conjunctivitis or vernal conjunctivitis, this is really the top of the line choice.

Side Effects: If prescribed for longer than 10 days, your doctor should check your intraocular pressure.  The incidence of significant (greater than 10 mm Hg) increase in IOP over a 28 day trial period with Alrex use was 2% of patients.  Contraindicated in patients with a history of herpes simplex infections or concurrent fungal infections.