Allergic conjunctivitis/eye allergies

[Rebecca Petris]

allergy drop alternatives

Random comments....

I heard very positive reports from a couple of optometrists at a conference recently about Similisan allergy drops.

I had a call from an optometrist in the Miami Beach area yesterday who gave glowing reports of their results with NutraTear on patients with allergy eyes.

[kakinda]

Hi Rebecca,
could you elaborate on Similisan (or send me a webpage on it)?
are these preservative free drops? (orthewise it may again be worse than having nothing).

take care
Kakinda

[Rebecca Petris]

They're homeopathics. I've never used them myself, so I can't report anything firsthand, but there's a few threads on the BB about it. Interestingly one of the ODs who talked to me about them said that they didn't like the Similisan dry eye drops but loved the one for allergies and used it regularly on dry eye patients.

Here's a link: http://www.similasanusa.com/faqs.cfm.

[sazy123]

In the past year several different doctors have put me on allergy drops, because they all said i have allergies: sodium chromogate (3 months)last summer, NHS doc put me on rapitol (2 months), and another one gave me patonol (1 week)- thought my eyes felt more dry after using it so i gave up. None of them helped with any of my DES symptoms, my eyes didnt feel any better after any of these time frames, so i didnt see the point in staying on them. But now im thinking i should have given them more time? As ive read some articles about allergy related dry eye, and after my last doctor said that i have allergies and inflammation on my lids (which are red inside) which maybe having an effect on the tear film.

Does any one think the time frames mentioned above were long enough to know whether an allergy eye drop is helping or not? or are they different (work quicker) to restasis-which takes a while to get the inflammation down?

Ive always been reluctant to belive that allergy is the main problem coz i never had a problem with allergies in my eyes before they went dry, i dont get all the normal symtoms for allergies like itchy, watering, red etc. I just get all the symptoms for dry eye. And i kind of think that the doctors kept pushing the allergy thing becuase it was the easy option, when they dont really know whats going on..i mean i know i have signs of allergies but after first few allergy drops I used didnt work- i kind of gave up on the idea, believing that something else is the culpret. Plus the steroids have not worked so for either..

[kakinda]

Hi again Sazy,

dry eye sufferers are more prone to get allergies, for several reason, but a simple one for instance is that the allergen stays longer in the eye (no tears to remove them frequently)... so it maybe be worth considering that option even if the medication you took usually improves things rather quicly (when it's appropriate).

Avoid Patanol (contains benzalkonium) and avoid long term used of steroids (glaucoma, cataract, etc)...

So, maybe try to clean your eyes very, very frequently (physiological saline solution at 0.9%)... and see if it improves things... that what i do amongst a million of other things.

Thanks Rebecca for the info on Similisan ... I've never had much luck with homeopathics (or results should i say) but I'd like to read more on it.
In dry eye care it's worth considering almost anything that's not dangerous (notably preservatives).

Take care,

[sazy123]

We cannot get Similisan in europe, ive tried to go through the drugstore.com. I really do not understand why they bother offering an international shipping service, when they hardly ship anything, and when they do they add like $80 on to the price just for the privilege and no ones gonna pay that for an over the counter product..ridiculous!

[neil0502]

Don't know about the OTC stuff, but I've heard uniformly good things about Patanol (Rx).

http://www.patanol.com/

Good luck!

Can't seem to actually edit, or remove this post, though I'd like to.

I posted without looking. Everybody was right: Patanol IS preserved with Benzalkonium Chloride.

I apologize. Based on that alone, I would never/will never recommend it to any dry eye person.

I prostrate myself before you all and beg forgiveness.....

[Scout]

Thank you Neil

Thank you Neil for your warnings on BAK. I use Zaditor regularly and have done so for probably too many years. It is similar to Patanol and also uses BAK as a preservative. I have had allergic conjunctivitis for many years and it complicates and is complicated by dry eyes. I think I have been quite hesitant to give up the Zaditor because it has helped so much and I guess I am afraid to stop something that works well. However, I know from my own personal experience with a medication that I was prescribed when I was 19, medications that are effective and helpful in the short-run are not always beneficial in the long-run and may even cause harm.
You spoke. I listened. I should have known better.
I went to Target today and bought Similasan allergy drops. I hope it helps as much as the Zaditor.
Scout

[kakinda]

Hello,

Patanol like many other eye drops contains benzalkonium chloride or BAK for short …, but they shouldn’t if laboratories were to respect our eyes. I have posted a webpage in French on this subject in Keratos’ website (Europe). If you are able to read French please do have a look at it at: http://keratos.free.fr/

Otherwise, here a list of preservatives every type of fragile eye should avoid whenever possible:
1.BAK (benzalkonium)
2. thimerosal (or thiomersal in certain European countries)
3. chlorobutanol
4. EDTA
5. chlorhexidine digluconate

Since the seventies, laboratories are aware of the risk of allergy reaction to these substances, some of them are abrasive for the human healthy eye (let alone for severe dry eyes….), some increase the oxydative stress on the ocular surface…
Exactly what you need to avoid in a dry eye and otherwise fragile eye!
Several studies have demonstrated that even for “regular eyes”, drops containing the above- mentioned preservatives should never been regularly (more than 3 times a day or more than 10 ten days). Since these drops are used for allergic conjunctivitis or dry eyes (or otherwise unhealthy eyes), pathologies that clearly usually last longer than that, it is absurd that laboratories don’t produce single use vials if they’re worried about possible contamination.

Even if one is not allergic to one of these components, by being constantly exposed to that specific preservative one may develop an allergic reaction. And then you therapeutic options are clearly limited.
The fact alone that there are very little options in terms of antibiotics without preservative is also criminal on the part of laboratories. And so have told me my docs (I have seen France’s top ophthalmologists including one who did one of the studies I mentioned).

I have written to Alcon and several other laboratories on this issue, here are some illustrative replies:
“At this time, Alcon has no plans to market OPATANOL in single unit vials without preservatives. Alcon does market a new product, SYSTANE Lubricant Eye Drop which is the first artificial tear clinically proven to reduce both signs and symptoms of dry eye. This product contains POLYQUAD as the preservative, not benzalkonium chloride as in OPATANOL."
By the way, I do not request any info on Systane but they never miss a chance to sell something else even if it contains an allegedly less dangerous preservatives (polyquad).
"Thank you for your note of inquiry regarding the availability of olopatadine in unit dose vials. I am sorry to hear of your dry eye condition, as I have experience in this area I appreciate that dry eye can be very difficult.
At the current time we are not developing unit dose vials for olopatadine but I appreciate your suggestion as I understand for patients that have a sensitivity to BAK."
Yes, Neil, Olopatadine is an interesting drug and before it caused an ulcer in my left eye last year I believe I can say it had a beneficial impact on my allergies… but then again it’s not worth such a dangerous consequence. Neil: Have you been able to find Acular PF (preservative free)? If you do please tell us how it worked for you.

Hi Rebecca and all, as I mentioned in a previous thread (Keratos I guess), I hope we will a launch a campaign to raise awareness on the risks of BAK and other preservatives, a campaign in favour of single use vials or some different way of preserving drops (in France there’s a system called ABAK to avoid contamination of drops). That is clearly the way to go. In the meanwhile maybe we could have a permanent thread on the dangers of preservatives in eye drops and if we were all to write to the main laboratories asking them to produce unpreserved drops maybe we could induce a change… just a suggestion. I have done so… I hope you’ll follow my initiative. It’s quite easy to send an email to laboratories isn’t it… and it’s certainly worth trying considering the risks.

Take care… avoid preservatives… and write to laboratories,
Kakinda

One additional comment though: if you are using an antibiotic drops (even if it contains Bak or the like) you shouldn’t stop using it because of what I’ve said (because it can be even more dangerous that the preservative), however, whenever you can, stay away from preserved drops.

[kitty]

For Kakinda....

Yes, Neil, Olopatadine is an interesting drug and before it caused an ulcer in my left eye last year I believe I can say it had a beneficial impact on my allergies… but then again it’s not worth such a dangerous consequence. Neil: Have you been able to find Acular PF (preservative free)?

Kakinda, how do you know it was Olopatadine that caused your ulcer and not something else?

[kakinda]

Hello
Again, it wasn't olopatadine which caused the ulcer but very likely the preservative contained in it...

well, it did not have an erosion from January to late June last and then (late June last year, during it allergic period) I used Opatanol (or Patanol in the US) for about 2 weeks ... and then i had my ulcer.

I also noticed some allergic reaction to the product...latough my allergies were less severe... I have had previous problem with BAK-preserved drops before. Does all that sound like a coincidence to you?

Take care,
Kakinda

[kitty]

I was just wondering if you might have rubbed your eye or had been wearing contact lenses, or if there could have been any other reason for the ulcer. I don't see eye ulcers listed under possible adverse reactions on the product insert.

[neil0502]

I was just wondering if you might have rubbed your eye or had been wearing contact lenses, or if there could have been any other reason for the ulcer. I don't see eye ulcers listed under possible adverse reactions on the product insert.

Unfortunately, I see this as part of the problem.

The list of citations that I provided--indicating the damage that BAC can, and does, do--was FAR FROM exhaustive. I have, maybe, 100 articles??

The problem here would be that we have to understand how the FDA requires that clinical trials be structured for ophthalmic products. If you truly use a randomised sample of the population, then what are the chances that you'll get a dry eye person?

If you don't get a dry eye person in your sample, BUT you do measure TBUT and Schirmer's (if not more: histopathologic exam of the eye), then you'll likely see that SUBCLINICAL damage WAS done.

If you DO get a dry eye person in your sample, then that's likely to account for the adverse effects like "stinging, burning, dry eye, photophobia," etc., etc. that we all know too well.

But how long do people use these drops? Do they have plugs or cautery (dramatically increasing "residence time" of the drops)?

There are so many variables that I don't actually EXPECT the clinical trials to uncover all the potentials, though I DO think that ophthalmic meds SHOULD use a "special groups" category of "Dry Eye Patients" since we're likely to become their largest constituents.

[kakinda]

I was just wondering if you might have rubbed your eye or had been wearing contact lenses, or if there could have been any other reason for the ulcer. I don't see eye ulcers listed under possible adverse reactions on the product insert.

As you won't see listed oxydative stress, abrasive for the human epithelium, accumulation in the human epithelium, etc...in those leaflets...

guess why...

Neil stressed on a very important issue, these substance were mainly studied on healthy eyes under normal conditions but somehow that's not their target group...but what's strange is it that eye drops undergo phase II studies which require labs to involve patients and not just healthy subjects... but again are these severe dry eyes?
or rather very moderate dry eyes?
do healthy eyes need eye drops by the way?
So i guess these products should be as safe as possible for unhealthy corneas and therefore should never contain preservatives.

[Scout]

Similasan

Just a quick note re: Similasan

I tried Similasan for 2 weeks. I have made the sad conclusion that not only does it not work for me to help with allergies, it actually is *yet* another drop that I have a sensitivity to. Within a few minutes of using it, my eyes were worse. Much worse.

I guess I will step up on the NutraTear (pretty much the only drop I have ever found that doesn't cause this reaction/sensitivity/inflammation) to try to wash out the gunk from the allergies.

Scout