Topical corticosteroid valuable option in allergic conjunctivitis care

Key Points

New York-For patients who are suffering with moderate to severe signs and symptoms of seasonal or perennial allergic conjunctivitis, loteprednol etabonate ophthalmic suspension 0.2% (Alrex, Bausch & Lomb) is a safe and well-tolerated therapeutic option that can provide rapid clinical improvement, according to Jai G. Parekh, MD, MBA.

"I feel very comfortable prescribing a short course of loteprednol etabonate 0.2% when patients require potent action and fast relief of their ocular allergy signs and symptoms and even over a longer course in patients who need ongoing control for allergic conjunctivitis refractory to other pharmacotherapeutic options," Dr. Parekh added.

A 30-year-old female engineering professional who presented at the beginning of the spring allergy season represents a typical patient who may be treated with loteprednol etabonate 0.2% for management of seasonal allergic conjunctivitis. The patient had nasal polyps, rhinitis, and a history of asthma and pollen allergy.

Although she was instructed annually about measures for minimizing allergen exposure and has been prescribed topical medications with combination antihistamine/mast cell stabilizing properties to control her ocular allergy, she generally was noncompliant with the advice until she became very symptomatic.

The patient is an avid golfer and presented with complaints of blurry vision, severe itchy eyes, and intermittent foreign-body sensation. Ocular examination revealed moderate conjunctival hyperemia, impressive papillary reaction, and discharge consistent with exacerbation of her seasonal allergic conjunctivitis.

"As a corticosteroid, loteprednol targets both the early and late phases of the allergic reaction by acting on multiple pathways," Dr. Parekh said. "[Treating] this patient [with] loteprednol etabonate 0.2% three or four times a day will provide effective symptomatic control within a few days and [it] is very well-tolerated in patients with irritated eyes because its glycerin-containing, slightly viscous vehicle is soothing on instillation."

The topical corticosteroid generally is combined with refrigerated artificial tears, which provide added comfort and help clear allergens from the ocular surface, and depending on the disease severity, perhaps with a multimodality over-the-counter (OTC) or prescription topical anti-allergy product, according to Dr. Parekh.

Patients are followed for therapeutic response. Often, the corticosteroid can be tapered after just a few weeks and the patient transitioned to use of a combination anti-allergy product alone. However, loteprednol etabonate 0.2% may be re-initiated as rescue therapy if needed or maintained for longer-term use.