ARTIFICIAL TEARS
Place in Therapy
Place in therapy
Most literature on allergic conjunctivitis is in agreement that ocular lubricating agents such as saline solution or artificial tears are useful for the initial treatment options for mild seasonal allergic conjunctivitis (SAC) (1). They work primarily by physically irrigating, diluting, and removing allergens that may come into contact with the conjunctival surface. (1) They can also moisten the eyes, which often become dry when irritated [1]. These agents only provide temporary relief and neither treat the underlying allergic reaction nor modify the inflammatory mediators (1). If tear substitutes are inadequate, ointments or time-released tear replacements may be used at night to provide moisture to the ocular surface (1). The recommendations on the use of ocular lubricating agents for the treatment of mild SAC are mostly based on theoretical rationale and expert opinions since there is limited scientific evidence. There is only one primary literature that investigates the effectiveness and safety of ocular lubricants. One study showed that a single instillation of one drop of topical antihistamine, levocabastine, was more effective than that of artificial tears in controlling acute symptoms of allergic conjunctivitis (2). The efficacy and safety of lubricating agents in special populations such as infants, children, pregnant and lactating women have not been demonstrated. The product monograph indicates that the use of artificial tears is contraindicated in children under 3 years old (3).
References
1. Bielory, BP, O’Brien T, Bielory L. Management of seasonal allergic conjunctivitis: guide to therapy. Acta Ophthalmol. 2011 Nov 8 doi: 10.1111/j.1755-3768.2011.02272.x. [Epub ahead of print]
2. Fujishima H, Fukagawa K, Takano Y, et al. The Early Efficacy of Topical Levocabastine in Patients with Allergic Conjunctivitis. Allergol Int. 2006 Sep;55(3):301-3.
3. Refresh Tears Lubricating Eye Drops product monograph. http://home.intekom.com/pharm/allergan/refre-tr.html#CONTRA-INDICATIONS. Accessed June 21, 2012
4. Terrie, YC, Bowling, EL. Update on the OTC Treatment of Allergies: Focus on Allergic Conjunctivitis. Pharmacy Times Office of Continuing Professional Education. https://secure.pharmacytimes.com/lessons/200903-02.asp. Accessed May 28, 2012.
5. Friesen, A. Conjunctivitis. In: Canadian Pharmacists Association. Patient Self-Care, 2nd ed. Ottawa, ON: Canadian Pharmacist Association, 2010
Most literature on allergic conjunctivitis is in agreement that ocular lubricating agents such as saline solution or artificial tears are useful for the initial treatment options for mild seasonal allergic conjunctivitis (SAC) (1). They work primarily by physically irrigating, diluting, and removing allergens that may come into contact with the conjunctival surface. (1) They can also moisten the eyes, which often become dry when irritated [1]. These agents only provide temporary relief and neither treat the underlying allergic reaction nor modify the inflammatory mediators (1). If tear substitutes are inadequate, ointments or time-released tear replacements may be used at night to provide moisture to the ocular surface (1). The recommendations on the use of ocular lubricating agents for the treatment of mild SAC are mostly based on theoretical rationale and expert opinions since there is limited scientific evidence. There is only one primary literature that investigates the effectiveness and safety of ocular lubricants. One study showed that a single instillation of one drop of topical antihistamine, levocabastine, was more effective than that of artificial tears in controlling acute symptoms of allergic conjunctivitis (2). The efficacy and safety of lubricating agents in special populations such as infants, children, pregnant and lactating women have not been demonstrated. The product monograph indicates that the use of artificial tears is contraindicated in children under 3 years old (3).
References
1. Bielory, BP, O’Brien T, Bielory L. Management of seasonal allergic conjunctivitis: guide to therapy. Acta Ophthalmol. 2011 Nov 8 doi: 10.1111/j.1755-3768.2011.02272.x. [Epub ahead of print]
2. Fujishima H, Fukagawa K, Takano Y, et al. The Early Efficacy of Topical Levocabastine in Patients with Allergic Conjunctivitis. Allergol Int. 2006 Sep;55(3):301-3.
3. Refresh Tears Lubricating Eye Drops product monograph. http://home.intekom.com/pharm/allergan/refre-tr.html#CONTRA-INDICATIONS. Accessed June 21, 2012
4. Terrie, YC, Bowling, EL. Update on the OTC Treatment of Allergies: Focus on Allergic Conjunctivitis. Pharmacy Times Office of Continuing Professional Education. https://secure.pharmacytimes.com/lessons/200903-02.asp. Accessed May 28, 2012.
5. Friesen, A. Conjunctivitis. In: Canadian Pharmacists Association. Patient Self-Care, 2nd ed. Ottawa, ON: Canadian Pharmacist Association, 2010