Mast cell stabilizer ideal for giant papillary conjunctivitis

Miami-Despite the presence of new therapies for ocular allergies on the market, nedocromil sodium ophthalmic solution 2% (Alocril, Allergan) may be an effective choice for some patients, said William Trattler, MD, in private practice at the Center for Excellence in Eye Care, Miami.

However, Dr. Trattler turns to nedocromil sodium in cases such as giant papillary conjunctivitis (GPC), a common cause of irritated eyes in people who wear contact lenses. He explained that some chronic contact lens wearers develop significant changes on the internal surface of the palpebral conjunctiva.

"Nedocromil sodium is a powerful mast cell stabilizer and also works well to suppress the late-phase inflammatory cascade of ocular allergy," Dr. Trattler said.

He also said that patients should abstain from wearing contact lenses while using steroids for treatment of GPC and, in severe cases, may have to cease lens wear for several weeks or longer.

Nedocromil sodium is also useful in cases of vernal conjunctivitis. As with GPC, Dr. Trattler prescribes nedocromil sodium in conjunction with steroids.

"My goal is to use the combination of steroids and nedocromil sodium to suppress the inflammation, and then taper off the steroids due to issues with cataract formation and IOP elevation," he said. "Nedocromil sodium reduces the total amount of steroid needed to control the condition."

Dr. Trattler generally uses medications other than nedocromil sodium for treatment of routine ocular allergies. He noted that the product is effective in such cases and would be his choice if a patient's insurance would not cover other allergy medications or if a patient could not use one of the combination agents.

"Nedocromil sodium is clearly another effective option for patients with known seasonal allergies who want to use medication to prevent the onset of allergy symptoms," he said.

He cited a 2001 study by Dr. Alexander et al. of the prophylactic use of nedocromil sodium in 24 golfers with known ragweed-pollen allergy (See Ophthalmology Times, May 1, 2002). The golfers used the eye drops 4 days before a golf course intervention and 15 minutes before starting a round of golf during peak ragweed season. Players were assessed for symptoms before, during, and after the game. It was observed that symptom severity scores decreased about 30 minutes after instillation, and improvements persisted for 8 to 12 hours.