Effectiveness of Nonpharmacologic Treatments for Acute Seasonal Allergic Conjunctivitis

Bilkhu, P.S., Wolffsohn, J.S., Naroo, S.A., Robertson, Louise and Kennedy, Roy (2014) Effectiveness of Nonpharmacologic Treatments for Acute Seasonal Allergic Conjunctivitis. Ophthalmology, 121 (1). pp. 72-78. ISSN 0161-6420

Abstract

Objective
To investigate whether artificial tears and cold compress alone or in combination provide a treatment benefit and whether they were as effective as or could enhance topical antiallergic medication.

Design
Randomized, masked clinical trial.

Participants
Eighteen subjects (mean age, 29.5±11.0 years) allergic to grass pollen.

Intervention
Controlled exposure to grass pollen using an environmental chamber to stimulate an ocular allergic reaction followed by application of artificial tears (ATs), 5 minutes of cold compress (CC), ATs combined with CC, or no treatment applied at each separate visit in random order. A subset of 11 subjects also had epinastine hydrochloride (EH) applied alone and combined with CC in random order or instillation of a volume-matched saline control.

Main Outcome Measures
Bulbar conjunctival hyperemia, ocular surface temperature, and ocular symptoms repeated before and every 10 minutes after treatment for 1 hour.

Results
Bulbar conjunctival hyperemia and ocular symptoms decreased and temperature recovered to baseline faster with nonpharmaceutical treatments compared with no treatment (P < 0.05). Artificial tears combined with CC reduced hyperemia more than other treatments (P < 0.05). The treatment effect of EH was enhanced by combining it with a CC (P < 0.001). Cold compress combined with ATs or EH lowered the antigen-raised ocular surface temperature to less than the pre-exposure baseline. Artificial tear instillation alone or CC combined with ATs or EH significantly reduced the temperature (P < 0.05). Cold compress combined with ATs or EH had a similar cooling effect (P > 0.05). At all measurement intervals, symptoms were reduced for both EH and EH combined with CC than CC or ATs alone or in combination (P < 0.014).

Conclusions
After controlled exposure to grass pollen, CC and AT treatment showed a therapeutic effect on the signs and symptoms of allergic conjunctivitis. A CC enhanced the use of EH alone and was the only treatment to reduce symptoms to baseline within 1 hour of antigenic challenge. Signs of allergic conjunctivitis generally were reduced most by a combination of a CC in combination with ATs or EH.

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