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308 Ocular inflammation
Other RCT data have demonstrated that painful symptoms of adenoviral
conjunctivitis are significantly reduced with topical antihistamine/decongestant
drops; symptom duration is also reduced, from eight to five days. 27 Typical
combination drops include naphazoline hydrochloride (0.025%) and
pheniramine (0.3%); the combination therapy is administered in a dose of
1–2 dropsQID.
For seasonal allergic conjunctivitis, RCT data comparing two topical anti-
histamines demonstrated superiority (at assessment at both 5 and 21 days)
of BID ketotifen fumarate (0.025%) ophthalmic solution over olopatadine
hydrochloride (0.1%) ophthalmic solution. 28 Large-scale RCT evidence has
demonstrated efficacy, as well as safety, of ketotifen (0.025%) in adults and
children. 29 A relatively nonsedating antihistamine, mizolastine (10 mg PO
QD), is demonstrated by RCT data to provide significant relief (compared
with placebo) for allergic rhinoconjunctivitis; the additional symptom relief
for rhinitis is an additional advantage to this agent. 30
In an RCT assessing QID topical therapy for allergic conjunctivitis, the
antimetabolite mitomycin C (0.2 mg/10 mL) was more effective than the
topical antihistamine azelastine (0.02%) for both symptom relief and resolution
of signs; the use of topical mitomycin C in such low doses does not
cause any significant adverse effect. 31
The mast cell stabilizer lodoxamide appears to be somewhat useful, but only if
given very early in, or even as prophylaxis against, allergic conjunctivitis. 32
Another mast cell stabilizer, nedocromil sodium (2%), is also effective in reducing
burning (and other symptoms) of allergic conjunctivitis. 33 Because of their primary
utility as preventive agents, the mast cell stabilizers are not first-line choices
for ED therapy of allergic conjunctivitis, unless there are reasons to avoid other
agents (and even then, only if patients present very early in the disease course).
For keratoconjunctivitis photoelectrica (ultraviolet light injury such as
from welding), consensus guidelines acknowledge the limited available evidence
but endorse limited (i.e. in the ED) use of topically applied local
anesthetics such as proparacaine (0.5%). 34 Their application in the ED
provides 15–20 min of anesthesia, which facilitates physical examination,
and the local anesthetics have been reported useful for ocular pain indications
as unusual as conjunctivitis occurring after eye exposure to spider