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A novel ophthalmic anti-allergy agent, epinastine HCl ophthalmic solution 0.05% (Elestat, Inspire Pharmaceuticals), effectively controls ocular allergy in patients with dry eye, according to Jodi Luchs, MD, FACS. The drop has been shown to rapidly prevent ocular allergy symptoms by blocking H1 and H2 receptors, stabilizing mast cells, and inhibiting the release of proinflammatory mediators.
"Epinastine is a powerful medication for the control of ocular allergies, with comprehensive action against multiple aspects of the allergic inflammatory cascade," said Dr. Luchs, who is the director of the Department of Refractive Surgery and Cornea Service at the North Shore/Long Island Jewish Health System, Great Neck, NY.
"It has a long duration of action of at least 12 hours, which justifies its true b.i.d. dosing schedule," he continued. "Furthermore, it does not worsen ocular surface dryness, unlike some other topical medications in its class, which list dryness as one of the side effects on the package label, and it has been shown to improve contact lens tolerance in patients with allergic conjunctivitis."
To illustrate the efficacy of epinastine, Dr. Luchs, who also is assistant clinical professor, Department of Ophthalmology, Albert Einstein College of Medicine, Bronx, NY, discussed the case study of a 47-year-old woman who presented to him with itchy eyes and redness.
The patient reported chronically red eyes, foreign body sensation, and chronic mild itch. She had been prescribed daily-wear contact lenses but could no longer wear them because of her symptoms.
She used over-the-counter (OTC) antihistamines/vasoconstrictors twice daily but had recently switched to four-times-a-day dosing because her symptoms had worsened. She also used preserved artificial tears.
A careful patient history revealed that she had eczema as a child and her parents had had allergies. She had seen multiple doctors during the past few years, and she used multiple medications including full-strength steroids, "soft" steroids, and topical antihistamines. All had provided temporary relief when her symptoms flared, but she preferred OTC medications. The patient said that oral antihistamines worsened her symptoms.
Upon examination, the patient had 20/20 corrected vision and an acceptable contact lens fit. She exhibited minimal papillary reaction on palpebral conjuctiva, a mild punctate corneal fluorescein stain, and a reduced tear lake. Schirmer testing with anesthesia was 7 mm.
Diagnostic considerations in this patient included allergy, dry eye, or both. Dr. Luchs diagnosed perennial allergic conjunctivitis with seasonal exacerbation. She had moderate dry eye syndrome and was dependent on OTC ocular decongestants. He instructed the patient to stop the OTC antihistamine/vasoconstrictor and prescribed epinastine to be taken twice a day.
The patient also received preservative-free tears and patient education regarding the chronicity of her condition. Additionally, she was referred to an allergist for allergy testing, during which she tested positive for ragweed and cat dander, but she refused to part with her cat, Dr. Luchs said.
At follow-up, the patient reported a marked reduction in baseline itch and irritation, resolved gritty/foreign body/dry sensation, and greatly improved contact lens tolerance.
She no longer experiences seasonal flare of symptoms nor uses OTC products.