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COVER STORY
Treatment
on a Budget
Clinicians must help guide cost-conscious patients in their use of
over-the-counter drops for the treatment of ocular allergy.
BY DAVID A. GOLDMAN, MD
A
s unemployment rates stay high and more
people lose insurance coverage, an increasing
number of patients are asking their physicians
for cheaper alternative medications. The prevalence of ocular allergy is at least four times that of nasal
allergy symptoms,1 and some of the least expensive
antiallergy drops are available over the counter. In a
majority of cases, they cost less than generic prescription
medications. The question is, do they work? In short, the
answer is yes, but not all over-the-counter (OTC) drops
are created equal. It is the duty of eye care professionals
to steer patients in the right direction. There are well
over a dozen OTC antiallergy drops, but they are mainly
composed of one or two similar active ingredients.
PHENIRAMINE MALEATE/NAPHAZOLINE
Pheniramine maleate/naphazoline is the common
ingredient in products such as Naphcon-A (Alcon
Laboratories, Inc., Fort Worth, TX) and Opcon-A
(Bausch + Lomb, Rochester, NY). The combination of an
antihistamine and a vasoconstrictor can increase
patients’ ocular comfort and decrease hyperemia.
Multiple clinical studies have proven the efficacy of this
combination.2,3 Unfortunately, rebound hyperemia and
chemosis are frequent. Furthermore, a reactive conjunctivitis can occur that may take months to resolve.4
KETOTIFEN FUMARATE
Ketotifen fumarate is the common ingredient in the
majority of OTC antiallergy drops, including Zaditor
(Novartis Pharmaceuticals Corporation, East Hanover,
NJ), Alaway (Bausch + Lomb), Zyrtec Itchy Eye (Pfizer
Inc., New York, NY), and Claritin Eye (Schering-Plough
Corporation, Kenilworth, NJ). A second-generation H1antihistamine/mast cell stabilizer, ketotifen effectively
treats the signs and symptoms of ocular allergy. It has
been found to be more efficacious at reducing ocular
54 ADVANCED OCULAR CARE MARCH 2010
A sampling of the antiallergy drops that are available over
the counter.
itching and redness than fluorometholone acetate in the
treatment of seasonal allergic conjunctivitis.5 In a comparative study, 0.025% ketotifen fumarate was superior
to 0.1% olopatadine hydrochloride for the relief of the
signs and symptoms of vernal conjunctivitis.6 In a study
of patients’ preferences regarding the treatment of allergic conjunctivitis, however, individuals preferred
olopatadine drops to ketotifen drops, because they
found the former more efficacious and comfortable.7
Since the completion of this study, Alcon Laboratories,
Inc., has released olopatadine hydrochloride ophthalmic
solution 0.2% as a once-daily, dosed, antiallergy drop
(Pataday). Although the q.d. dosing certainly lends itself
to better compliance, it can come at a significant financial cost to patients.
ALTERNATIVE REMEDIES
Similasan Allergy Eye Relief (Similasan Corporation,
Highlands Ranch, CO) is a homeopathic eye drop with
active ingredients listed as apis, euphrasia, and sabadilla.
COVER STORY
Some patient-reported anecdotes of clinical success
notwithstanding, there are no clinical studies proving
any benefit to this product.
SUMMARY
OTC drops can be very effective for treating the signs
and symptoms of ocular allergy, and they can be especially helpful to patients who have been hit hard by the
current US economy. Although naphazoline/pheniramine
maleate combination drops have proven beneficial in
clinical trials, more evidence supports the use of ketotifen fumarate drops, which do not share the potential
problem of rebound hyperemia and chemosis. Unfortunately, not all patients with allergic conjunctivitis
will respond to drops containing ketotifen fumarate. At
the very least, however, these OTC medications provide
an inexpensive and readily available starting point for
patients with allergic conjunctivitis. ■
David A. Goldman, MD, is an assistant professor
of clinical ophthalmology at Bascom Palmer Eye
Institute in Palm Beach Gardens, Florida. He is a
consultant to Alcon Laboratories, Inc.; Allergan,
Inc.; Aton Pharma, Inc.; Inspire Pharmaceuticals,
Inc.; and Sirion Therapeutics. Dr. Goldman may be reached at
(561) 515-1543; [email protected].
1. Singh K,Bielory L.Ocular allergy:a national epidemiologic study.J Allergy Clin Immunol.2007;119(1):S154-S154.
2. Dockhorn RJ,Duckett TG.Comparison of Naphcon-A and its components (naphazoline and pheniramine) in a provocative
model of allergic conjunctivitis.Curr Eye Res.1994;13(5):319-324.
3. Greiner JV,Udell IJ.A comparison of the clinical efficacy of pheniramine maleate/naphazoline hydrochloride ophthalmic
solution and olopatadine hydrochloride ophthalmic solution in the conjunctival allergen challenge model.Clin Ther.
2005;27(5):568-577.
4. Soparkar CN,Wilhelmus KR,Koch DD,et al.Acute and chronic conjunctivitis due to over-the-counter ophthalmic decongestants.Arch Ophthalmol.1997;115(1):34-38.
5.Borazan M,Karalezli A,Akova YA,et al.Efficacy of olopatadine HCI 0.1%,ketotifen fumarate 0.025%,epinastine HCI 0.05%,
emedastine 0.05% and fluorometholone acetate 0.1% ophthalmic solutions for seasonal allergic conjunctivitis:a placebocontrolled environmental trial [published online ahead of print July 9,2008].Acta Ophthalmol.2009;87(5):549-554.
6. Hida WT,Nogueira DC,Schaefer A,et al.Comparative study between 0.025% ketotifen fumarate and 0.1% olopatadine
hydrochloride in the treatment of vernal keratoconjunctivitis [in Portuguese].Arq Bras Oftalmol.2006;69(6):851-856.
7. Leonardi A,Zafirakis P.Efficacy and comfort of olopatadine versus ketotifen ophthalmic solutions:a double-masked,environmental study of patient preference.Curr Med Res Opin.2004;20(8):1167-1173.
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