Fundamental Aspects and Relevance of Components in Antihistamine Eye Drops.

Ocular allergy covers a series of immune-allergic inflammatory diseases of the ocular surface, with different degrees of involvement and severity. These pathologies are caused by a variety of IgE- and non-IgE-mediated immune mechanisms and may involve all parts of the external eye, including the conjunctiva, cornea, eyelids, tear film, and commensal flora. The most frequent is allergic conjunctivitis, a condition with different clinical forms that are classified according to the degree of involvement and the presence or absence of proliferative changes in the palpebral conjunctiva, associated atopic dermatitis, and mechanical stimuli by foreign bodies, including contact lenses. Treatment guidelines for allergic conjunctivitis propose a stepwise approach that includes medications for both ophthalmic and oral administration depending on symptom severity, allergic comorbidities, and degree of control. In the case of antihistamines, eye drops are the most prescribed ophthalmic formulations. To avoid disrupting the delicate balance of the ocular surface, topical ophthalmic medications must be well tolerated. The primary aim of this article is to review the physicochemical characteristics and other features of excipients (preservative agents, buffers, pH adjusters, viscosity enhancers, wetting agents or cosolvents, antioxidants, tonicity adjusters, and osmo-protectants) and active compounds (ocular antihistamines) that must be considered when developing formulations for ophthalmic administration of antihistamines. We also provide a brief overview of antihistamine eye drops that could be of interest to professionals treating ocular allergy and encourage the use of preservative-free formulations when possible.

The Importance of Preventing and Managing Tear Dysfunction Syndrome in Allergic Conjunctivitis and How to Tackle This Problem.

Tear dysfunction syndrome, also known as dry eye disease (DED), is a multifactorial disease of the ocular surface characterized by the loss of tear film homeostasis. DED shows a significant clinical overlap with ocular allergy (OA), which alters tear film homeostasis, thus predisposing the patient to DED. Both conditions constitute the most common ocular surface disorders and have a potentially severe impact on patients' quality of life. Clinical practice guidelines recommend topical therapies as first-line treatment for OA. However, eye drop formulations may contain additional substances that can contribute to ocular surface damage and the development of DED. Therefore, physicians treating ocular allergy should be aware of problems affecting the tear film, the role of tear film disruption in OA, and topical treatment to prevent or minimize DED. The aim of this review is to present an updated overview of the topic.

Fundamental Aspects and Relevance of Components in Antihistamine Eye Drops

Ocular allergy covers a series of immune-allergic inflammatory diseases of the ocular surface, with different degrees of involvement and severity. These pathologies are caused by a variety of IgE- and non–IgE-mediated immune mechanisms and may involve all parts of the external eye, including the conjunctiva, cornea, eyelids, tear film, and commensal flora. The most frequent is allergic conjunctivitis, a condition with different clinical forms that are classified according to the degree of involvement and the presence or absence of proliferative changes in the palpebral conjunctiva, associated atopic dermatitis, and mechanical stimuli by foreign bodies, including contact lenses. Treatment guidelines for allergic conjunctivitis propose a stepwise approach that includes medications for both ophthalmic and oral administration depending on symptom severity, allergic comorbidities, and degree of control. In the case of antihistamines, eye drops are the most prescribed ophthalmic formulations.To avoid disrupting the delicate balance of the ocular surface, topical ophthalmic medications must be well tolerated. The primary aim of this article is to review the physicochemical characteristics and other features of excipients (preservative agents, buffers, pH adjusters, viscosity enhancers, wetting agents or cosolvents, antioxidants, tonicity adjusters, and osmo-protectants) and active compounds (ocular antihistamines) that must be considered when developing formulations for ophthalmic administration of antihistamines. (AU)

El término alergia ocular engloba un conjunto de enfermedades inflamatorias de la superficie ocular de origen inmunoalérgico, con distintos niveles de afectación y gravedad. Están causadas por una variedad de mecanismos inmunes, mediados o no por IgE y pueden involucrar a todos los componentes de la superficie ocular, incluyendo conjuntiva, córnea, párpados, película lagrimal y flora comensal. De estos trastornos, el más común es la enfermedad alérgica conjuntival. En su clasificación se incluyen distintas formas clínicas según el nivel de afectación y la presencia o no de cambios proliferativos en la conjuntiva palpebral, asociación con dermatitis atópica, y estímulos mecánicos por cuerpo extraño, incluyendo lentes de contacto. Las guías terapéuticas para el tratamiento de la conjuntivitis alérgica proponen un tratamiento escalonado, tanto en administración oftálmica como oral, en función de la gravedad de los síntomas, las comorbilidades alérgicas del paciente y el logro de un control adecuado. En general, cuando los síntomas oculares predominan o se presentan de forma aislada, se prefieren las formulaciones oftálmicas de antihistamínicos de administración tópica y, dentro de estas, los colirios. Para mantener el equilibrio de la superficie ocular, las formulaciones tópicas oftálmicas deben mostrar una buena tolerancia. El objetivo principal de este artículo es revisar las características y otras propiedades de los excipientes (conservantes, tampones, agentes para ajustar el pH, viscosizantes, agentes humectantes o cosolventes, antioxidantes, isotonizantes y osmoprotectores) y sustancias activas (antihistamínicos oculares) que deben ser considerados cuando se formulan los preparados de administración tópica oftálmica de agentes antihistamínicos. (AU)

The Importance of Preventing and Managing Tear Dysfunction Syndrome in Allergic Conjunctivitis and How to Tackle This Problem

Tear dysfunction syndrome, also known as dry eye disease (DED), is a multifactorial disease of the ocular surface characterized by the loss of tear film homeostasis. DED shows a significant clinical overlap with ocular allergy (OA), which alters tear film homeostasis, thus predisposing the patient to DED. Both conditions constitute the most common ocular surface disorders and have a potentially severe impact on patients’ quality of life. Clinical practice guidelines recommend topical therapies as first-line treatment for OA. However, eye drop formulations may contain additional substances that can contribute to ocular surface damage and the development of DED. Therefore, physicians treating ocular allergy should be aware of problems affecting the tear film, the role of tear film disruption in OA, and topical treatment to prevent or minimize DED. The aim of this review is to present an updated overview of the topic. (AU)

El síndrome de disfunción lagrimal, también denominado enfermedad del ojo seco (EOS), es una enfermedad multifactorial de la superficie ocular caracterizada por la pérdida de la homeostasis de la película lagrimal. La EOS y la alergia ocular (AO) son patologías que comparten un abanico de signos y síntomas, y pueden aparecer simultáneamente; además, la AO altera la homeostasis de la película lagrimal, predisponiendo a la EOS. Estas dos afecciones constituyen los trastornos más frecuentes de la superficie ocular y pueden afectar notablemente la calidad de vida de los pacientes. Las guías de práctica clínica recomiendan terapias tópicas como tratamiento de primera línea para la alergia ocular. Sin embargo, las fórmulas de los colirios pueden contener aditivos y conservantes que pueden contribuir al daño de la superficie ocular y a la aparición de EOS. Por lo tanto, los facultativos que tratan la alergia ocular deben conocer las implicaciones que conlleva la alteración de la película lagrimal en la conjunctivitis alérgica, el potencial daño que pueden provocar los conservantes incluidos en los colirios empleados en el tratamiento tópico de esta patología, así como los tratamientos disponibles para manejar la EOS y la AO cuando la disfunción de la película lacrimal ya está establecida. El objetivo de esta revisión es presentar una visión general actualizada del tema. (AU)

Análisis de superficie ocular en pacientes diagnosticados de ictiosis X / Ocular surface analysis in patients diagnosed with X-linked ichthyosis

Se estudió a 7 pacientes (14 ojos) diagnosticados de ictiosis X mediante test de Schirmer, biomicroscopia, tonometría, recuento endotelial, tomografía de coherencia óptica, Pentacam, analizador de superficie ocular y microscopia confocal. La edad media fue 33,83 ± 20,17 años (rango: 7-64 años). Los hallazgos más frecuentes en biomicrocoscopia fueron disfunción de glándulas de Meibomio (83,3%) y opacidades corneales estromales (33%). El tiempo de rotura de la película lagrimal se encontró acortado en el 25% de los ojos. La microscopia confocal (2 ojos) reveló queratocitos activados con partículas hiperreflectivas en su interior en estroma anterior y fuera de ellos en estroma posterior. Creemos que la extensión del uso de la microscopia confocal permitirá conocer mejor la enfermedad corneal asociada a ictiosis X y nuevas características de estos pacientes

Seven patients (14 eyes) diagnosed with X-linked ichthyosis were studied using the Schirmer test, biomicroscopy, tonometry, endothelial count, optical coherence tomography, Pentacam®, ocular surface analyser, and confocal microscopy. The mean age was 33.83 ± 20.17 years (range: 7-64 years). The most frequent findings in biomicroscopy were Meibomian glands dysfunction (83.3%) and stromal corneal opacities (33%). The tear break-up time was found shortened in 25% of the eyes. Confocal microscopy (both eyes) revealed activated keratocytes with hyper-reflective particles inside them in the anterior stroma and outside them in the posterior stroma. It is believed that the inclusion of the use of confocal microscopy will help in a better understanding of the corneal pathology associated with ichthyosis X, as well as new characteristics of these patients

Ocular surface analysis in patients diagnosed with X-linked ichthyosis. / Análisis de superficie ocular en pacientes diagnosticados de ictiosis X.

Seven patients (14 eyes) diagnosed with X-linked ichthyosis were studied using the Schirmer test, biomicroscopy, tonometry, endothelial count, optical coherence tomography, Pentacam®, ocular surface analyser, and confocal microscopy. The mean age was 33.83±20.17 years (range: 7-64 years). The most frequent findings in biomicroscopy were Meibomian glands dysfunction (83.3%) and stromal corneal opacities (33%). The tear break-up time was found shortened in 25% of the eyes. Confocal microscopy (both eyes) revealed activated keratocytes with hyper-reflective particles inside them in the anterior stroma and outside them in the posterior stroma. It is believed that the inclusion of the use of confocal microscopy will help in a better understanding of the corneal pathology associated with ichthyosis X, as well as new characteristics of these patients.

[Effectiveness and impact in the quality of life of ketotifen ophthalmic solution. Results of zeta study in patients with seasonal allergic conjunctivitis]. / Efectividad e impacto en la calidad de vida del colirio de ketotifeno. Resultados del estudio zeta en pacientes con conjuntivitis alérgica estacional.

PURPOSE: To study the effectiveness of ketotifen ophthalmic solution (0.25 mg/ml) in seasonal allergic conjunctivitis (SAC) and the impact on the patient's quality of life. METHODS: A multicentric, longitudinal, prospective study was designed. 284 Spanish ophthalmologists participated recruiting 1145 patients with SAC. After obtaining the informed consent, a drop of ketotifen ophthalmic solution was instilled. At the visit, clinical symptoms pre and post-treatment were assessed. The patients answered a questionnaire of quality of life (QOL) pre-treatment and minimum one week after initiating the treatment. The qualitative variables were described by the percentage, and the quantitative were described by the average, median, standard deviation, and maximum and minimum values. The effectiveness (change of intensity of the symptoms) and the quality of life were studied by the Wilcoxon test with a significance level of 5% (alpha = 0.05). RESULTS: Following the instillation of the ketotifen ophthalmic solution the intensity of the ocular symptoms (redness, edema, tearing, secretion, photophobia and visual acuity impairment) decreased significantly. Comparing both QOL, we observed a statistically significant reduction of the limitation perceived by the patients in their daily activities, animic state and ocular symptoms. In 0,7% some adverse event was referred, none was serious and only in one case the probable relationship with the drug was specified. CONCLUSION: The results of the ZETA study demonstrate the tolerability and effectiveness of the ketotifen ophthalmic solution for all the symptoms of SAC in clinical practice, observing improvement in the quality of life of the patient.

Practical experience with a high Dk lotrafilcon A fluorosilicone hydrogel extended wear contact lens in Spain.

PURPOSE: Several research studies on high Dk soft contact lens materials have been published, but little has been reported from practical clinical experience with these new materials. This study reports in-practice clinical experience with the lotrafilcon A fluorosilicone hydrogel material from a 6-month study in Spain. METHODS: Eighty-five patients were dispensed lotrafilcon A lenses (Focuse NIGHT & DAY [CIBA Vision Corporation]) for monthly replacement by 13 investigators from eight practices. The recommended wear schedule was daily wear for the first week and then up to 6-night extended wear through the first month and up to 30-night extended wear through 6 months. Follow-up visits were at 1 week, 1 month, 3 months, and 6 months. Clinical and patient subjective data were collected at each visit. RESULTS: Among patients who continued in the study at each visit, Snellen visual acuity (VA) of 20/25 or better was achieved by at least 96% of all eyes at all visits; lens surfaces assessments for front surface deposits, front surface wetting, and back surface debris averaged less than grade 1 (0-4 scale) for all lenses at all visits; biomicroscopy grades averaged well below grade 1 (0-4 scale) for all eyes at all visits; acceptable or optimal fit was assessed for 97% or more of all lenses at all visits. These patients rated the average overall comfort, vision, and handling above 9 (0-10 scale) at 6 months and 98% reported satisfaction with the lenses at 6 months. Eighty-two percent of patients dispensed completed the study. Seven patients were discontinued because of fit, and seven were discontinued because of positive biomicroscopy signs. CONCLUSIONS: The lotrafilcon A lens performed well clinically and it was accepted well by patients, with most practitioners recommending and most patients wearing it for up to 30 nights extended wear. Practitioners should be attentive to fit and discomfort complaints at dispensing and follow-up and may want to recommend lubricating or rewetting drops for those patients with dryness symptoms.