In the study published in Archives of Ophthalmology in January 1997, Soparkar and colleagues set out to describe patterns of conjunctivitis caused by over-the-counter ophthalmic decongestants. The previous warning label did not specify narrow angle glaucoma. The proposed warning would also specify that patients with narrow angle glaucoma should not take the product except under the supervision of a physician. The warning could also include a statement to the effect that the dilation is temporary and not harmful. The proposed new warning label language would include the phrase, 'Pupils may become dilated.' 23 Federal Register seeks to include a new warning statement for over-the-counter ophthalmic drug products containing ephedrine, naphazoline, phenylephrine and tetrahydrozaline. This effect has not gone unnoticed by the Food and Drug Administration, which has received more than 400 adverse drug experience reports of pupil dilation since approving the over-the-counter use of three topical antihistamine-vasoconstrictor products in the past 3 years. 'The vasoconstrictive effects of those medicines, when used over and over, can cause a chronic inflammation or dilation of the conjunctival blood vessels.'

'That study documented cases of chronic conjunctivitis because of patient chronic use and abuse of these readily available, over-the-counter medicines,' Dr.

He noted a study published last year in Archives of Ophthalmology to underscore this point.

Thomas said, which in turn can lead to chronic conjunctivitis. These combination ophthalmic decongestants contain one of the following vasoconstrictors - naphazoline, tetrahydrozoline or phenylephrine - and can be misused by patients, Dr. 'However, the exception to this can be found in those former prescription drugs that are now over-the-counter.' Beware of OTC agents Thomas said none of his patients has experienced any adverse effects with these prescription-only anti-allergy medicines. 'Livostin is the one we're most comfortable with,' he said, 'and after that it's a toss-up between Patanol (olopatadine, Alcon) and Acular (ketorolac tromethamine, Allergan), which are two fine additional eye drops.'ĭr. Thomas agreed there is a wide choice of allergy medicines today and that, in his practice, Livostin (levocabastine HCl, Ciba Vision) is the drop prescribed most often. 'Artificial tears, which are 100% safe, can cure a whole bunch of pseudo or secondary allergy problems.'ĭr. 'In many patients, if you treat the dry eye problem, the secondary opportunistic allergy expression just goes away because, in fact, they're dry,' he said. Don't forget dry eyeĪnother caveat with allergy treatment is that many patients who suffer from ocular allergies also have dry eyes therefore, treating the dry eye component should be part of any therapy, said Randall Thomas, OD, FAAO, who is in practice in Concord, N.C. And in some cases, patients can actually cause chronic conjunctivitis before you see them in the office. Inexpensive and accessible, patients often misuse and overuse these products because they do not consider them medication. Many of the newer, second-generation antihistamines offer patients the benefits of allergy relief without the side effects of their first-generation predecessors, namely, drowsiness and dry mouth.īut when considering which new anti-allergy medicine is right for your patient, you may also want to quiz patients on which over-the-counter ophthalmic decongestants or decongestant/antihistamine they might be using. With an increasing number of antihistamines available, it seems there is no allergy your patients cannot conquer once you have made the proper diagnosis. If you continue to have this issue please contact to Healio

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