, Volume 8, Issue 4, pp 250–264 | Cite as

Optimal Use of Topical Agents for Allergic Conjunctivitis

  • Ralph Mösges
  • Hassan A. Hassan
  • Martin R. Wenzel
Disease Management


In recent years, there has been renewed interest in the topical treatment of allergic conjunctivitis, a disorder that is involved in the common red-eye syndrome. Topical treatment for rapid relief of symptoms is most often preferred by the patient, although physicians are more cautious with the choice of an agent that might worsen symptoms due to contact irritation induced by the substance or its preservative. Theoretical advantages of topical over oral administration include a more rapid onset of action, since the active agent is applied directly to the affected tissue, and a reduced potential for systemic adverse effects.

The range of topical agents currently available for the treatment of allergic conjunctivitis varies widely. The 4 primary aims when considering local drug application are: (i) rapid symptomatic relief (particularly applicable to local vasoconstrictors and histamine antagonists); (ii) prophylactic therapy (mast cell stabilisers); (iii) avoidance of systemic adverse reactions (eye drops containing corticosteroids); and (iv) direct route of administration (specific ocular immunotherapy).

In this article we review the underlying pathological mechanisms, present a clinical and diagnostic overview and discuss the available therapeutic options. Finally, we present our treatment strategy, which is based on the nature of the disorder and the patient’s expectations. In seasonal or perennial conjunctivitis the combination of decongestants and antihistamines should be first choice for palliative treatment. Mast cell stabilisers should be used as prophylaxis, while immunotherapy can provide a cure. In vernal and atopic keratoconjunctivitis, the decongestant/antihistamine combination can be used for long-term treatment, while courses of topical corticosteroids may prevent flares. Mast cell stabilisers, with lodoxamide in the first place, are used for prophylactic therapy. Surgery may be useful in handling complications. In giant papillary conjunctivitis, hygienic measures regarding contact lenses are mandatory, and sodium cromoglycate (cromolyn sodium) may provide rapid relief. In contact conjunctivitis, removal or avoidance of the sensitiser is most important. Topical use of corticosteroids should be limited to severe cases.


Conjunctivitis Allergy Clin Immunol Terfenadine Sodium Cromoglycate Nedocromil 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Bonini S, Bonini S. IgE and non-IgE mechanisms in ocular allergy. Ann Allergy 1993 Sep; 71(3): 296–9PubMedGoogle Scholar
  2. 2.
    Foster CS. The pathophysiology of ocular allergy: current thinking [see discussion pp. 34–8]. Allergy 1995; 50 Suppl. 21: 6–9PubMedCrossRefGoogle Scholar
  3. 3.
    Lightman S. Therapeutic considerations: symptoms, cells and mediators [see discussion pp. 34–8]. Allergy 1995; 50 Suppl. 21: 10–13PubMedCrossRefGoogle Scholar
  4. 4.
    Montan PG, Biberfeld PJ, Scheynius A. IgE, IgE receptors, and other immunocytochemical markers in atopic and nonatopic patients with vernal keratoconjunctivitis. Ophthalmology 1995 May; 102(5): 725–32PubMedGoogle Scholar
  5. 5.
    Helleboid L, Khatami M, Wie ZG, et al. Histamine and prostacyclin: primary and secondary release in allergic conjunctivitis. Invest Ophthalmol Vis Sci 1991 Jul; 32(8): 2281–9PubMedGoogle Scholar
  6. 6.
    Mita H, Sakuma Y, Shida T, et al. Release of chemical mediators in the conjunctival lavage fluids after eye provocation with allergen or compound 48/80 [in Japanese]. Arerugi 1994 Jul; 43(7): 800–8PubMedGoogle Scholar
  7. 7.
    Fukagawa K, Saito H, Azuma N, et al. Histamine and tryptase levels in allergic conjunctivitis and vernal keratoconjunctivitis. Cornea 1994 Jul; 13(4): 345–8PubMedCrossRefGoogle Scholar
  8. 8.
    Abelson MB, Baird RS, Allansmith MR. Tear histamine levels in vernal conjunctivitis and other ocular inflammations. Ophthalmology 1980; 87: 812–4PubMedGoogle Scholar
  9. 9.
    Elgebaly SA, Donshik PC, Rahhal F, et al. Neutrophil chemotactic factors in the tears of giant papillary conjunctivitis patients. Invest Ophthalmol Vis Sci 1991 Jan; 32(1): 208–13PubMedGoogle Scholar
  10. 10.
    Lambiase A, Bonini S, Bonini S, et al. Increased plasma levels of nerve growth factor in vernal keratoconjunctivitis and relationship to conjunctival mast cells. Invest Ophthalmol Vis Sci 1995 Sep; 36(10): 2127–32PubMedGoogle Scholar
  11. 11.
    Rivasi F, Cavallini GM, Longanesi L. Cytology of allergic conjunctivitis: presence of airborne, nonhuman elements. Acta Cytol 1992 Jul–Aug; 36(4): 492–8PubMedGoogle Scholar
  12. 12.
    Bryant DH, Burns MW, Lazarus L. Identification of IgG antibody as a carrier of reaginic activity in asthmatic patients. J Allergy Clin Immunol 1975; 56: 417–28PubMedCrossRefGoogle Scholar
  13. 13.
    Bonini S, Bonini S, Bucci MG, et al. Early and late conjunctival reactions. In: Miyamoto T, Okuda M, editors. Progress in allergy and clinical immunology. Vol. 2. Seattle: Hogrefe & Huber, 1992: 77–82Google Scholar
  14. 14.
    Lemanske Jr RF, Kalmer MA. Late phase allergic reactions. In: Middleton E, Reed CE, Ellis EF, et al., editors. Allergy: principles and practice. 3rd ed. St Louis: Mosby, 1988: 224–6Google Scholar
  15. 15.
    Bonini S, Bonini S, Todini V, et al. Late phase ocular reaction induced by conjunctival allergen challenge: a dose response study in humans. J Allergy Clin Immunol 1988; 81: 173CrossRefGoogle Scholar
  16. 16.
    Trocme SD, Bonini S, Barney NP, et al. Late phase reaction in topically induced ocular anaphylaxis in the rat. Curr Eye Res 1988; 7: 437–43PubMedCrossRefGoogle Scholar
  17. 17.
    Leonardi A, Secchi AG, Briggs R, et al. Conjunctival mast cells and the allergic late phase reaction. Ophthalmic Res 1992; 24(4): 234–42PubMedCrossRefGoogle Scholar
  18. 18.
    Solley GO, Gleich GJ, Jordon RE. The late phase of the immediate wheal and flare skin reaction: its dependence upon IgE antibodies. J Clin Invest 1976; 58: 408–20PubMedCrossRefGoogle Scholar
  19. 19.
    Springer T. Adhesion receptors of the immune system. Nature 1990; 346: 425–33PubMedCrossRefGoogle Scholar
  20. 20.
    Wegner CD, Gundel RH, Reilly P, et al. Intercellular adhesion molecules-1 (ICAM-1) in the pathogenesis of asthma. Science 1990; 257: 456–9CrossRefGoogle Scholar
  21. 21.
    Canonica GW, Ciprandi G, Pesce GP, et al. ICAM-1 on epithelial cells in allergic subjects: a hallmark of allergic inflammation. Int Arch Allergy Immunol 1995 May–Jun; 107(1–3): 99–102PubMedCrossRefGoogle Scholar
  22. 22.
    Canonica GW, Ciprandi G, Buscaglia S, et al. Adhesion molecules of allergic inflammation: recent insights into their functional roles. Allergy 1994 Feb; 49(2): 135–41PubMedCrossRefGoogle Scholar
  23. 23.
    Ciprandi G, Pronzato C, Ricca V, et al. Allergen-specific challenge induces intercellular adhesion molecule 1 (ICAM-1 or CD54) on nasal epithelial cells in allergic subjects: relationships with early and late inflammatory phenomena. Am J Respir Crit Care Med 1994 Dec; 150 (6 Pt 1): 1653–9PubMedGoogle Scholar
  24. 24.
    Ciprandi G, Buscaglia S, Pesce GP, et al. ICAM-1/CD54 expression on conjunctival epithelium during pollen season. Allergy 1995 Feb; 50(2): 184–7PubMedCrossRefGoogle Scholar
  25. 25.
    Baudouin CH, Fredj-Reygrobellet D, Gastaud D, et al. HLADR and DQ distribution in normal human ocular structures. Curr Eye Res 1988; 7: 903–11PubMedCrossRefGoogle Scholar
  26. 26.
    Baudouin Ch, Haouat N, Brignole F, et al. Immunopathological findings in conjunctival cells using immunofluorescence staining of impression cytology specimens. Br J Ophthalmol 1992; 76: 545–9PubMedCrossRefGoogle Scholar
  27. 27.
    Ring J. Epidemiologie allergischer Erkrankungen. Munich: MMV, 1991Google Scholar
  28. 28.
    Weeke ER. Epidemiology of hay fever and perennial allergic rhinitis. Allergy 1987; 21: 1–20Google Scholar
  29. 29.
    Friedlaender MH. Conjunctivitis of allergic origin: clinical presentation and differential diagnosis. Surv Ophthalmol 1993 Jul–Aug; 38 Suppl.: 105–14PubMedCrossRefGoogle Scholar
  30. 30.
    Dart JKG, Buckley RJ, Monnickena M, et al. Perennial allergic conjunctivitis: definition, clinical characteristics and prevalence. Trans Ophthalmol Soc UK 1986; 105: 513–20PubMedGoogle Scholar
  31. 31.
    Tuft SJ, Kemeny DM, Dart JKG, et al. Clinical features of atopic keratoconjunctivitis. Ophthalmology 1991; 98: 150–8PubMedGoogle Scholar
  32. 32.
    Frankland AW, Easty D. Vernal keratoconjunctivitis: an atopic disease. Trans Ophthalmol Soc UK 1971; 91: 479–82PubMedGoogle Scholar
  33. 33.
    Donshik PC. Giant papillary conjunctivitis. Trans Am Ophthalmol Soc 1994; 92: 687–744PubMedGoogle Scholar
  34. 34.
    Brown MD, Potter JW. Floppy eyelid syndrome: a case report and clinical review. J Am Optom Assoc 1992 May; 63(5): 309–14PubMedGoogle Scholar
  35. 35.
    Friedlaender MH. Contact allergy and toxicity in the eye. Int Ophthalmol Clin 1988; 28: 317–20PubMedCrossRefGoogle Scholar
  36. 36.
    Hatinen A, Terasvirta M, Frakj JE. Contact allergy to components in topical ophthalmic preparations. Acta Ophthalmol (Copenh) 1985; 63: 424–6CrossRefGoogle Scholar
  37. 37.
    Sendle DP. Chemical hypersensitivity reactions. Int Ophthalmol Clin 1982; 26: 26–34Google Scholar
  38. 38.
    Moller C, Biorkksten B, Nilsson G, et al. The precision of the conjunctival provocation test. Allergy 1984; 39: 37–42PubMedCrossRefGoogle Scholar
  39. 39.
    Kari O, Salo OP, Halmepuro L, et al. Tear histamine during allergic conjunctivitis challenge. Graefes Arch Clin Exp Ophthalmol 1985; 223: 60–2PubMedCrossRefGoogle Scholar
  40. 40.
    Leonardi A, Fregona IA, Gismondi M, et al. Correlation between conjunctival provocation test (CPT) and systemic allergometric tests in allergic conjunctivitis. Eye 1990; 4: 760–4PubMedCrossRefGoogle Scholar
  41. 41.
    Abelson MB, Chambers WA, Smith LM. Conjunctival allergen challenge. Arch Ophthalmol 1990 Jan; 108: 84–8PubMedCrossRefGoogle Scholar
  42. 42.
    Tsubota K, Takamura E, Hasegawa T, et al. Detection by brush cytology of mast cells and eosinophils in allergic and vernal conjunctivitis. Cornea 1991; 10: 525–31PubMedCrossRefGoogle Scholar
  43. 43.
    Horak F, Berger U, Menapace R, et al. Quantification of conjunctival vascular reaction by digital imaging. J Allergy Clin Immunol 1996; 98(3): 495–500PubMedCrossRefGoogle Scholar
  44. 44.
    Abelson MB, Mediwale N, Weston JH. Conjunctival eosinophils in allergic ocular diseases. Arch Ophthalmol 1983; 101: 555–6PubMedCrossRefGoogle Scholar
  45. 45.
    Rivasi F, Cavallini GM, Longanesi L. Cytology of allergic conjunctivitis: presence of airborne, nonhuman elements. Acta Cytol 1992 Jul–Aug; 36(4): 492–8PubMedGoogle Scholar
  46. 46.
    Little EC, Garner LF. Eye protection from airborne allergens. J Am Optom Assoc 1986; 57: 462–4PubMedGoogle Scholar
  47. 47.
    Dale S, Landmar E. Characterisation of allergens in a crude extract of Dermatophagoides farinae and their identification in a new purified preparation. Allergy 1985; 39: 572–85CrossRefGoogle Scholar
  48. 48.
    Durham SR, Varney V, Gaga M, et al. Immunotherapy and allergic inflammation. Clin Exp Allergy 1991 Jan; 21 Suppl. 1: 206–10PubMedCrossRefGoogle Scholar
  49. 49.
    Ortolani C, Pastorello EA, Incorvaia C, et al. A double-blind, placebo-controlled study of immunotherapy with an alginate-conjugated extract of Parietaria judaica in patients with Parietaria hay fever. Allergy 1994 Jan; 49(1): 13–21PubMedCrossRefGoogle Scholar
  50. 50.
    Varney VA, Gaga M, Frew AJ, et al. Usefulness of immunotherapy in patients with severe summer hay fever uncontrolled by antiallergic drugs. BMJ 1991; 302: 265–9PubMedCrossRefGoogle Scholar
  51. 51.
    Lofkvist T, Agrell B, Dreborg S, et al. Effects of immunotherapy with a purified standardized allergen preparation of Dermatophagoides farinae in adults with perennial allergic rhinoconjunctivitis. Allergy 1994 Feb; 49(2): 100–7PubMedCrossRefGoogle Scholar
  52. 52.
    Del Prete A, Loffredo C, Carderopoli A, et al. Local specific immunotherapy in allergic conjunctivitis. Acta Ophthalmol (Copenh) 1994 Oct; 72(5): 631–4CrossRefGoogle Scholar
  53. 53.
    Altounyan REC. Review of the clinical activity and modes of action of sodium cromoglycate. In: Pepys J, Edwards AM, editors. The mast cell: its role in health and disease. London: Pitman Medical, 1979: 199–216Google Scholar
  54. 54.
    Bernstein IL, Johnson CL, Tse CST. Therapy with cromolyn sodium. Ann Intern Med 1978; 89: 228–33PubMedGoogle Scholar
  55. 55.
    Foster CS. Evaluation of topical cromolyn sodium in the treatment of vernal keratoconjunctivitis. Ophthalmology 1988 Feb; 95(2): 194–201PubMedGoogle Scholar
  56. 56.
    Dawson JP. Comparative trial of 2% sodium cromoglycate unit dose eye drops in seasonal allergic conjunctivitis. In: Pepys J, Edwards AM, editors. The mast cell: its role in health and disease. London: Pitman Medical, 1979: 506–11Google Scholar
  57. 57.
    Lindsay-Miller ACM. Group comparative trial of 2% sodium cromoglycate (Opticrom) with placebo in the treatment of seasonal allergic conjunctivitis. Clin Allergy 1979; 9: 279–5Google Scholar
  58. 58.
    Bec P, Berard P, Bonnet M, et al. Sodium cromoglycate eyewash in allergic conjunctivitis: multicentric controlled double-blind study. Review of the literature [in French]. J Fr Ophtalmol 1982; 5(11): 727–32PubMedGoogle Scholar
  59. 59.
    Friday GA, Biglan AW, Hiles-DA, et al. Treatment of ragweed allergic conjunctivitis with cromolyn sodium 4% ophthalmic solution. Am J Ophthalmol 1983 Feb; 95(2): 169–74PubMedCrossRefGoogle Scholar
  60. 60.
    Van Bijsterveld OP. A double-blind crossover study comparing sodium cromoglycate eye drops with placebo in the treatment of chronic conjunctivitis. Acta Ophthalmol (Copenh) 1984 Jun; 62(3): 479–84CrossRefGoogle Scholar
  61. 61.
    Hechanova Jr MG. A double blind study comparing sodium cromoglycate eye ointment with placebo in the treatment of chronic allergic conjunctivitis. Clin Trials J 1984; 21: 59–66Google Scholar
  62. 62.
    Kray KT, Squire EN, Tipton WR, et al. Cromolyn sodium in seasonal allergic conjunctivitis. J Allergy Clin Immunol 1985; 76: 623–7PubMedCrossRefGoogle Scholar
  63. 63.
    Ruggieri ML, Scorcia G. Double blind group comparative trial of sodium cromoglycate eye treatment and placebo in the treatment of allergic eye diseases. Ann Allergy 1987; 58: 105–12Google Scholar
  64. 64.
    Meisler DM, Berzins UJ, Krachmer JH, et al. Cromolyn treatment of giant papillary conjunctivitis. Arch Ophthalmol 1982 Oct; 100(10): 1608–10PubMedCrossRefGoogle Scholar
  65. 65.
    Kazadan JJ, Crawford JS, Langer H, et al. Sodium cromoglycate (Intal) in the treatment of vernal keratoconjunctivitis and allergic conjunctivitis. Can J Ophthalmol 1976 Oct; 11(4): 300–3Google Scholar
  66. 66.
    Tabbara KF, Arafat NT. Cromolyn effects on vernal keratoconjunctivitis in children. Arch Ophthalmol 1977 Dec; 95(12): 2184–6PubMedCrossRefGoogle Scholar
  67. 67.
    Sayegh F, Samerra’e S, Khateeb M. Clinical trial of topical disodium cromoglycate in vernal keratoconjunctivitis. Ophthalmologica 1978; 177(4): 208–13PubMedCrossRefGoogle Scholar
  68. 68.
    Foster SC, Duncan J. Randomized clinical trial of topically administrated cromolyn sodium for vernal keratoconjunctivitis. Am J Ophthalmol 1980; 92: 175–81Google Scholar
  69. 69.
    Juniper EF, Guyatt GH, Ferrie PJ, et al. Sodium cromoglycate eye drops: regular versus ‘as needed’ use in the treatment of seasonal allergic conjunctivitis. J Allergy Clin Immunol 1994 Jul; 94(1): 36–43PubMedCrossRefGoogle Scholar
  70. 70.
    Leino M, Montan P, Nja F. A double-blind group comparative study of ophthalmic sodium cromoglycate, 2% four times daily and 4% twice daily, in the treatment of seasonal allergic conjunctivitis. Allergy 1994 Mar; 49(3): 147–51PubMedCrossRefGoogle Scholar
  71. 71.
    Felius K, Van Bijsterveld OP. Effect of sodium cromoglycate on tear film break-up time. Ann Ophthalmol 1984; 16: 80–2PubMedGoogle Scholar
  72. 72.
    Dixon M, Jackson DM, Richards IM. The action of sodium cromoglycate on C-fibre endings in the dog lung. Br J Pharmacol 1980; 70: 11–3PubMedCrossRefGoogle Scholar
  73. 73.
    Kay AB, Walsh GM, Moqbel R, et al. Disodium cromoglycate inhibits activation of human inflammatory cells in vitro. J Allergy Clin Immunol 1987; 80: 1–8PubMedCrossRefGoogle Scholar
  74. 74.
    Yuasa T, Tada R, Nakagwa Y, et al. Long term study of disodium cromoglycate eye drops in the treatment of vernal conjunctivitis [in Japanese]. Folia Ophthalmol Jpn 1982; 32: 2265–72Google Scholar
  75. 75.
    Moqbel R, Cromwell O, Kay AB. The effect of nedocromil sodium on human eosinophil activation. Drugs 1989; 37 Suppl. 1: 19PubMedCrossRefGoogle Scholar
  76. 76.
    Borish L, Williams J, Johnson S, et al. Anti-inflammatory effects of nedocromil sodium: inhibition of alveolar macrophage function. Clin Exp Allergy 1992; 22: 984–90PubMedCrossRefGoogle Scholar
  77. 77.
    Verleden GM, Belvisi MG, Stretton CD, et al. Nedocromil sodium modulates non-adrenergic, non-cholinergic broncho-constrictor nerves in guinea pig airways in vitro. Am Rev Respir Dis 1991; 143: 114–8PubMedGoogle Scholar
  78. 78.
    Stockwell A, Easty DL. Group comparative trial of 2% nedocromil sodium with placebo in the treatment of seasonal allergic conjunctivitis. Eur J Ophthalmol 1994; 4: 19–23PubMedGoogle Scholar
  79. 79.
    Leino M, Carlson C, Jaanio E, et al. Double-blind group comparative study of 2% nedocromil sodium eye drops with placebo eye drops in the treatment of seasonal allergic conjunctivitis. Ann Allergy 1990 Apr; 64(4): 398–402PubMedGoogle Scholar
  80. 80.
    Blumenthal M, Casale T, Dockhorn R, et al. Efficacy and safety of Nedocromil Sodium ophthalmic solution in the treatment of seasonal allergic conjunctivitis. Am J Ophthalmol 1992; 113: 56–63PubMedGoogle Scholar
  81. 81.
    Melamed J, Schwartz RH, Hirsch R, et al. Evaluation of nedocromil sodium 2% ophthalmic solution for the treatment of seasonal allergic conjunctivitis. Ann Allergy 1994; 73: 57–66PubMedGoogle Scholar
  82. 82.
    Miglior M, Scullica L, Secchi AG, et al. Nedocromil sodium and astemizole, alone or combined, in the treatment of seasonal allergic conjunctivitis: a multicentre double blind clinical trial. Acta Ophthalmol (Copenh) 1993 Feb; 71(1): 73–8CrossRefGoogle Scholar
  83. 83.
    Leino M, Ennevaara K, Latvala AL, et al. Double-blind group comparative study of 2% nedocromil sodium eye drops with 2% sodium cromoglycate and placebo eye drops in the treatment of seasonal allergic conjunctivitis. Clin Exp Allergy 1992 Oct; 22(10): 929–32PubMedCrossRefGoogle Scholar
  84. 84.
    Kjellman M. Clinical experience with Tilavist: an overview of efficacy and safety. Allergy 1995; 50 Suppl. 21: 14–22PubMedCrossRefGoogle Scholar
  85. 85.
    Cerqueti PM, Ricaa V, Tosca MA, et al. Lodoxamide treatment of allergic conjunctivitis. Int Arch Allergy Immunol 1994; 105: 185–9PubMedCrossRefGoogle Scholar
  86. 86.
    Santos CI, Huang AJ, Abelson MB, et al. Efficacy of lodoxamide 0.1% ophthalmic solution in resolving corneal epitheliopathy associated with vernal keratoconjunctivitis. Am J Ophthalmol 1994 Apr 15; 117(4): 488–97PubMedGoogle Scholar
  87. 87.
    Caldwell DR, Verin P, Hartwich-Young R, et al. Efficacy and safety of lodoxamide 0.1% vs cromolyn sodium 4% in patients with vernal keratoconjunctivitis. Am J Ophthalmol 1992 Jun 15; 113(6): 632–7PubMedGoogle Scholar
  88. 88.
    Yanni JM, Weimer M, Glaser RL, et al. Effect of lodoxamide on in vitro and in vivo conjunctival immediate hypersensitivity responses in rats. Int Arch Allergy Immunol 1993; 101: 102–6PubMedCrossRefGoogle Scholar
  89. 89.
    Johnson HG. New antiallergy drugs — lodoxamide. Trends Pharmacol Sci 1980; 1: 343CrossRefGoogle Scholar
  90. 90.
    Frigas E, Reed CE. Effect of lodoxamide on allergy skin tests. J Allergy Clin Immunol 1980; 65: 257–62PubMedCrossRefGoogle Scholar
  91. 91.
    Floyd R, Kalpaxis J, Thayer T, et al. Double blind comparison of HEPP (IgE pentapeptide) 0.5% ophthalmic solution and sodium cromoglycate ophthalmic solution, USP 4% in patients having allergic conjunctivitis. Invest Ophthalmol Vis Sci 1988; 29: 45Google Scholar
  92. 92.
    Kalpaxis JG, Austin TX. Clinical comparison of IgE pentapeptide (HEPP) and cromolyn (Opticrom) in allergic conjunctivitis. Ann Allergy 1987; 85: 291Google Scholar
  93. 93.
    Corre A, Greze JF, Mounier G, et al. Intraindividual double-blind comparative study of the immediate ocular tolerability of the Na+ and Mg++ salts of N-acetyl-aspartylglutamic acid (NAAGA). J Fr Ophtalmol 1991; 14: 559–63PubMedGoogle Scholar
  94. 94.
    Meijer F, Pogany K, Kok JH, et al. N-acetyl-aspartyl glutamic acid (NAAGA) topical eyedrops in the treatment of giant papillary conjunctivitis (GPC). Doc Ophthalmol 1993; 85(1): 5–11PubMedCrossRefGoogle Scholar
  95. 95.
    Favennec F, Cartos A. Zinc and seasonal conjunctivitis [in French]. Allerg Immunol (Paris) 1993; 25: 119–22Google Scholar
  96. 96.
    Duzman E, Warman A, Warman R. Efficacy and safety of topical oxymetazoline in treating allergic and environmental conjunctivitis. Ann Ophthalmol 1986 Jan; 18(1): 28–31PubMedGoogle Scholar
  97. 97.
    Breakey AS, Cinotti AA, Hirshman A, et al. A double blinded, multicentre controlled trial of 0.025% oxymetazoline ophthalmic solution in patients with allergic and non-infectious conjunctivitis. Pharmacotherapeutica 1980; 2: 353–6Google Scholar
  98. 98.
    Gilman AG, Goodman LS, Filman A, editors. Goodman and Gilmans the pharmacological basis of therapeutics. 6th ed. New York: Macmillan, 1980: 168–72Google Scholar
  99. 99.
    Abelson MB, Butrus SI, Weston JH, et al. Tolerance and absence of rebound vasodilatation following topical ocular decongestant usage. Ophthalmology 1984; 91: 1364–7PubMedGoogle Scholar
  100. 100.
    Norman PS. Newer antihistaminic agents. J Allergy Clin Immunol 1985; 76: 366PubMedCrossRefGoogle Scholar
  101. 101.
    Ciprandi G, Buscaglia S, Pesce G, et al. Cetirizine reduces inflammatory cell recruitment and ICAM-1 (or CD54) expression on conjunctival epithelium in both early- and late-phase reactions after allergen-specific challenge. J Allergy Clin Immunol 1995; 95: 612–21PubMedCrossRefGoogle Scholar
  102. 102.
    Panayotopoulos SM, Panayotopoulos ES. Efficacy of cetirizine in the treatment of seasonal allergic rhinoconjunctivitis. Ann Allergy 1990; 65: 146–8PubMedGoogle Scholar
  103. 103.
    Gambardella R. A comparison of the efficacy of azelastine nasal spray and loratidine tablets in the treatment of seasonal allergic rhinitis. J Int Med Res 1993 Sep–Oct; 21(5): 268–75PubMedGoogle Scholar
  104. 104.
    Boland N. A double blind study of astemizole and terfenadine in the treatment of perennial allergic rhinitis. Ann Allergy 1988; 61: 18–24PubMedGoogle Scholar
  105. 105.
    Miglior M, Scullica L, Secchi AG, et al. Nedocromil sodium and astemizole, alone or combined, in the treatment of seasonal allergic conjunctivitis: a multicentre double blind clinical trial. Acta Ophthalmol (Copenh) 1993; 71: 73–8CrossRefGoogle Scholar
  106. 106.
    Juniper EF, White J, Dolovich J. Efficacy of continuous treatment with astemizole (Hismanal) and terfenadine (Seldane) in ragweed pollen-induced rhinoconjunctivitis. J Allergy Clin Immunol 1988; 82: 670–5PubMedCrossRefGoogle Scholar
  107. 107.
    Leclercq-Foucart J, Fernere A, Vanden Bussche G. A double blind trial comparing astemizole and ketotifen in the suppression of hay fever symptoms. Curr Ther Res 1986; 39: 875–83Google Scholar
  108. 108.
    Saito Y, Baba S, Furuuchi I, et al. Double blind comparative study of terfenadine vs ketotifen on perennial allergic rhinitis. Otorhinolaryngology 1988; 31 Suppl. 7: 963–4Google Scholar
  109. 109.
    Grant SM, Goa KL, Fitton A, et al. Ketotifen: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic use in asthma and allergic disorders. Drugs 1990; 40: 412–48PubMedCrossRefGoogle Scholar
  110. 110.
    Ciprandi G, Buscaglia S, Pesce GP, et al. Protective effect of loratadine on specific conjunctival provocation test. Int Arch Allergy Appl Immunol 1991; 96: 344–7PubMedCrossRefGoogle Scholar
  111. 111.
    Ciprandi G, Buscaglia S, Catrullo A, et al. Loratadine in the treatment of cough associated with allergic rhinoconjunctivitis. Ann Allergy Asthma Immunol 1995; 75: 115–20PubMedGoogle Scholar
  112. 112.
    Olsen OT, Nuchel Petersen L, Hoi L, et al. Comparison of loratadine and terfenadine in allergic seasonal rhinoconjunctivitis with emphasis on nasal stuffiness and peak flow. Arzneimittel Forschung 1992; 42: 1227–31PubMedGoogle Scholar
  113. 113.
    Ciprandi G, Buscaglia S, Iudice A, et al. Protective effect of different doses of terfenadine on the conjunctival provocation test. Allergy 1992; 47: 309–12PubMedCrossRefGoogle Scholar
  114. 114.
    Kjellman NI, Andersson B. Terfenadine reduces skin and conjunctival reactivity in grass pollen allergic children. Clin Allergy 1986; 16: 441–9PubMedCrossRefGoogle Scholar
  115. 115.
    Pipkorn U, Bende M, Hedner J, et al. A double-blind evaluation of topical levocabastine, a new specific H1 antagonist in patients with allergic conjunctivitis. Allergy 1985 Oct; 40(7): 491–6PubMedCrossRefGoogle Scholar
  116. 116.
    Bende M, Pipkorn U. Topical levocabastine, a selective H1 antagonist, in seasonal allergic rhinoconjunctivitis. Allergy 1987 Oct; 42(7): 512–5PubMedCrossRefGoogle Scholar
  117. 117.
    Bischoff P, Gerber M. Multicenter evaluation of a new local antihistaminic drug (levocabastine) [in German]. Klin Monatsbl Augenheilkd 1992; 200(5): 354–7PubMedCrossRefGoogle Scholar
  118. 118.
    Janssens MM, Vanden Bussche G. Levocabastine: an effective topical treatment of allergic rhinoconjunctivitis. Clin Exp Allergy 1991 May; 21 Suppl. 2: 29–36PubMedCrossRefGoogle Scholar
  119. 119.
    Vermeulen J, Mercer M. Comparison of the efficacy and tolerability of topical levocabastine and sodium cromoglycate in the treatment of seasonal allergic rhinoconjunctivitis in children. Pediatr Allergy Immunol 1994; 5: 209–13PubMedCrossRefGoogle Scholar
  120. 120.
    The Livostin Study Group. A comparison of topical levocabastine and oral terfenadine in the treatment of allergic rhinoconjunctivitis. Allergy 1993 Oct; 48(7): 530–4CrossRefGoogle Scholar
  121. 121.
    Sohoel P, Freng BA, Kramer J, et al. Topical levocabastine compared with orally administered terfenadine for the prophylaxis and treatment of seasonal rhinoconjunctivitis. J Allergy Clin Immunol 1993 Jul; 92 (1 Pt 1): 73–81PubMedCrossRefGoogle Scholar
  122. 122.
    Odelram H, Bjorksten B, Klercker T, et al. Topical levocabastine versus sodium cromoglycate in allergic conjunctivitis. Allergy 1989 Aug; 44(6): 432–6PubMedCrossRefGoogle Scholar
  123. 123.
    Ciprandi G, Cerqueti PM, Sacca S, et al. Levocabastine versus cromolyn sodium in the treatment of pollen-induced conjunctivitis. Ann Allergy 1990 Aug; 65(2): 156–8PubMedGoogle Scholar
  124. 124.
    Frostad AB, Olsen AK. A comparison of topical levocabastine and sodium cromoglycate in the treatment of pollen-provoked allergic conjunctivitis. Clin Exp Allergy 1993; 23: 406–9PubMedCrossRefGoogle Scholar
  125. 125.
    Swedish GP Allergy Team. Topical levocabastine compared with oral loratadine for the treatment of seasonal allergic rhinoconjunctivitis. Allergy 1994; 49: 611–5CrossRefGoogle Scholar
  126. 126.
    Graue E. Effects of levocabastine ophthalmic solution (H1 receptor antagonist) on symptoms of vernal conjunctivitis: a prospective, randomised double-blind study [in Spanish]. Gac Med Mex 1994; 130(6): 481–6PubMedGoogle Scholar
  127. 127.
    Goes F, Blockhuys S, Janssens M. Levocabastine eye drops in the treatment of vernal conjunctivitis. Doc Ophthalmol 1994; 87(3): 271–81PubMedCrossRefGoogle Scholar
  128. 128.
    Zuber P, Pecoud A. Effect of levocabastine, a new H1 antagonist, in a conjunctival provocation test with allergens. J Allergy Clin Immunol 1988; 82(4): 590–4PubMedCrossRefGoogle Scholar
  129. 129.
    Rimas M, Kjellman NI, Blychert LO, et al. Topical levocabastine protects better than sodium cromoglycate and placebo in conjunctival provocation tests. Allergy 1990; 45: 18–21PubMedCrossRefGoogle Scholar
  130. 130.
    Abelson MB, George MA, Schaefer K, et al. Evaluation of the new ophthalmic antihistamine, 0.05% levocabastine, in the clinical allergen challenge model of allergic conjunctivitis. J Allergy Clin Immunol 1994 Sep; 94 (3 Pt 1): 458–64PubMedCrossRefGoogle Scholar
  131. 131.
    Abelson MB, George MA, Smith LM. Evaluation of 0.05% levocabastine versus 4% sodium cromolyn in the allergen challenge model. Ophthalmology 1995; 102: 310–6PubMedGoogle Scholar
  132. 132.
    Janssens M. Efficacy of levocabastine in conjunctival provocation studies. Doc Ophthalmol 1992; 82: 341–51PubMedCrossRefGoogle Scholar
  133. 133.
    Abelson MB, Smith LM. Evaluation in the histamine and compound 48/80 models of ocular allergy in humans. Ophthalmology 1988; 95: 1494–7PubMedGoogle Scholar
  134. 134.
    Van Wauwe JP. Animal pharmacology of levocabastine: a new type of H1-antihistamine well suited for topical application. In: Mygind N, Naclerio RM, editors. Rhinoconjunctivitis: new perspectives in topical treatment. Proceedings of the XIIIth International Congress of Allergology and Clinical Immunology; 1988 Oct; Montreux: 27–34Google Scholar
  135. 135.
    Abelson MB, Weintraub D. Levocabastine eye drops: a new approach for the treatment of acute allergic conjunctivitis. Eur J Ophthalmol 1994; 4(2): 91–101PubMedGoogle Scholar
  136. 136.
    McTavish D, Sorkin EM. Azelastine: a review of its pharmacodynamic and pharmacokinetic properties and therapeutic potential. Drugs 1989: 38(5): 778–798PubMedCrossRefGoogle Scholar
  137. 137.
    Ciprandi G, Buscaglia S, Catrullo A, et al. Azelastine eye drops reduce and prevent allergic conjunctival reaction and exert anti-allergic activity. Clin Exp Allergy 1996; 27: 182–91CrossRefGoogle Scholar
  138. 138.
    Giede-Tuch C, Bousquet J, Chuchalin AD, et al. Multinational investigation of the efficacy and safety of azelastine eye drops in the treatment of allergic conjunctivitis. Allergy 1997; 52 Suppl. 37: 199Google Scholar
  139. 139.
    Giede-Tuch C, Metzenauer P, Petzold U. Investigation of the efficacy and safety of azelastine, levocabastine and placebo eye drops in patients with seasonal allergic conjunctivitis. Allergy 1997; 52 Suppl. 37: 199Google Scholar
  140. 140.
    Siegel SC. Overview of corticosteroids therapy. J Allergy Clin Immunol 1985; 76: 312–20PubMedCrossRefGoogle Scholar
  141. 141.
    Shin DH, Frenkel RE, David R, et al. Effect of topical anti-inflammatory treatment on the outcome of laser trabeculoplasty: the Fluorometholone-Laser Trabeculoplasty Study Group. Am J Ophthalmol 1996; 122(3): 349–54PubMedGoogle Scholar
  142. 142.
    Holsclaw DS, Whitcher JP, Wong IG, et al. Supratarsal injection of corticosteroids in the treatment of refractory vernal keratoconjunctivitis. Am J Ophthalmol 1996; 121: 243–9PubMedGoogle Scholar
  143. 143.
    Abelson MB, Sloan J. Nonsteroidal anti-inflammatory drugs: current ophthalmic therapy. J Fla Med Assoc 1994; 81: 261–3PubMedGoogle Scholar
  144. 144.
    Vane J. The evaluation of non steroidal anti-inflammatory drugs and their mechanisms of action. Drugs 1987; 33 Suppl. 1: 18PubMedCrossRefGoogle Scholar
  145. 145.
    Abramson SB, Weissman G. The mechanisms of action of non-steroidal anti-inflammatory drugs. Arthritis Rheum 1989; 32: 1PubMedCrossRefGoogle Scholar
  146. 146.
    Abelson MB, Butrus SI, Weston SM. Aspirin therapy in vernal conjunctivitis. Am J Ophthalmol 1983; 95: 502–5PubMedGoogle Scholar
  147. 147.
    Lemrini F, Dafrallah L, Sebbahi F, et al. Treatment of vernal conjunctivitis with aspirin. Rev Int Trach Pathol Ocul Trop Subtrop Sante Publique 1989; 66: 119–27PubMedGoogle Scholar
  148. 148.
    Sacca S, Cerqueti PM, Rolando M, et al. Limpiego per via topica di aspirina nelle congiuntiviti allergiche. Boll Ocul 1988; 67: 193–7Google Scholar
  149. 149.
    Tauber J, Abelson M, Ostrov C, et al. A multicenter comparison of diclofenac sodium 0.1% and ketotorolac tromethamine 0.5% in patients with acute seasonal allergic conjunctivitis. Invest Ophthalmol Vis Sci 1994; 35 Suppl.: 1921Google Scholar
  150. 150.
    Van Husen H. Topical treatment of anterior ocular disease with diclofenac Na eye drops. Klin Monatsbl Augenheilkd 1986; 188: 615–9PubMedCrossRefGoogle Scholar
  151. 151.
    Murphy JE. Drug profile: Tanderil eye ointment. J Int Med Res 1973; 1: 136–40Google Scholar
  152. 152.
    Kaufmann Y, Chang AE, Robb RJ, et al. Mechanisms of action of cyclosporine A: inhibition of lymphokine secretion studied with antigen stimulated T cell hybridomas. J Immunol 1984; 133: 3107–11PubMedGoogle Scholar
  153. 153.
    Okudaira H, Sakurai L, Terado K, et al. Cyclosporine A-induced supression of ongoing IgE antibody formation in the mouse. Int Arch Allergy Appl Immunol 1986; 79: 164–8PubMedCrossRefGoogle Scholar
  154. 154.
    Kaan G, Ozden O. Therapeutic use of topical cyclosporine. Ann Ophthalmol 1993; 25: 182–6PubMedGoogle Scholar
  155. 155.
    Bleik JH, Tabbara KF. Topical cyclosporine in vernal keratoconjunctivitis. Ophthalmology 1991; 98: 1679–84PubMedGoogle Scholar
  156. 156.
    Secchi AG, Tognon MS, Leonardi A. Topical use of cyclosporine in the treatment of vernal keratoconjunctivitis. Am J Ophthalmol 1990; 110: 641–5PubMedGoogle Scholar
  157. 157.
    Wiens JJ, Jackson WB. New directions in therapy for ocular allergy. Int Ophthalmol Clin 1988; 28: 332–7PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 1997

Authors and Affiliations

  • Ralph Mösges
    • 1
  • Hassan A. Hassan
    • 2
  • Martin R. Wenzel
    • 3
  1. 1.Institute for Medical Statistics, Informatics and Epidemiology, Medical FacultyUniversity of CologneCologneGermany
  2. 2.Department of Otorhinolaryngology, Plastic Head and Neck Surgery, Medical FacultyUniversity of AachenGermany
  3. 3.Department of Ophthalmology, Medical FacultyUniversity of AachenGermany

Personalised recommendations