Patient Case 1 Conjunctivitis

What is the typical pathophysiology of allergic conjunctivitis?

Allergen exposure to pollen, animal dander, or topical ophthalmic preparations.

What are the typical signs and symptoms of allergic conjunctivitis?

Concurrent allergic rhinitis, pruritus, erythema, bilateral presentation, sandy/grittery feeling, watery discharge.

What are the 4 main goals of therapy in allergic conjunctivitis?

Remove allergens, reduce severity of allergic reaction, symptomatic relief, & protect ocular surface.

What is considered 1st line treatment BEFORE pharmacologic treatments?

Identification, removal, and/or avoidance of allergen. (e.g. air filters)

What is another form of non-pharmacologic treatment?

Cold compress TID/QID on closed eyes

What is considered first-line in pharmacologic treatment?

Non-prescription ocular lubricants

What are examples of non-prescription ocular lubricants?

Carboxymethylcellulose (Refresh Tears)

Polyethylene Glycol (Blink Tears)

What is considered second-line in pharmacologic treatment?

Topical H₁ antagonist antihistamine + mast cell stabilizer

What is the typical dosing regiment for topical H₁ antagonist antihistamine + mast cell stabilizer medications?

1 gtt qD/BID OU

What are examples of topical H₁ antagonist antihistamine + mast cell stabilizer medications?

Ketotifen (Alaway)

Olopatadine (Pataday)

Alcafatadine (Lastacaft)

What is one key counseling point/side effect for Ketotifen?

May cause pupil dilation

What is considered third-line for pharmacologic treatment of allergic conjunctivitis?

Systemic anthistamines

What are examples of non-sedating systemic antihistamines?

Cetirizine (Zyrtec)

Loratadine (Claritin)

Levocetirizine (Xyzal)

Fexofenadine (Allegra)

What is an example of a sedating systemic antihistamine?

Diphenhydramine (Benadryl)

What other drug class is utilized in pharmacologic treatment of allergic conjunctivitis?

Decongestants

What is the onset of decongestant medications for treatment of allergic conjunctivitis?

Immediate

What are the key patient counseling points for decongestant medications for treatment of allergic conjunctivitis?

Rebound redness, tachyphylaxis, do not use for > 72 hrs. (3 days)

What are examples of decongestant medications?

Naphazoline (Clear Eyes)

Tetrahydrozoline (Murine Plus)

Phenylephrine (Sudafed)

Oxymetazoline (Afrin)

What is the MOA of decongestant medications?

Mostly 𝜶1 agonists; can be 𝜶₂ agonist (Brimonidine)

What is the typical dosing regiment for decongestant medications?

1-2 gtt TID/QID OU

Which decongestant medication CAN be used >72 hrs. and does NOT cause rebound redness/tachyphylaxis (3 days)?

Brimonidine (Lumify)

What discharge is associated with bacterial conjunctivitis?

Thick, white/yellow discharge

What discharge is associated with viral conjunctivitis?

Watery/mucousy discharge

If bacterial conjunctivitis is diagnosed, what is the next step in treatment?

Medical referral