PURPOSE:

To assess the effect of topical Non-Steroidal Anti Inflammatory drugs in the treatment of allergic conjunctivitis.

METHOD:

Systematic Review.

DATA SOURCES AND STUDY SELECTION:

Reports of comparative randomized trials of topical NSAIDs and placebo identified by searches of Medline, Embase, the Cochrane Register of Controlled Trials.

DATA EXTRACTION AND SYNTHESIS:

Two reviewers assessed trials for eligibility and quality and extracted data independently. Data were synthesized (random effects model) and results expressed results for dichotomous outcomes as relative risk and continuous outcomes as weighted mean difference. Sensitivity analysis was used to examine potential heterogeneity by differences in study quality.

RESULTS:

Eight studies incorporating 712 patients were included. The difference between the decrease in allergic sign and symptom score for NSAID treatment compared to placebo was between 4 and 19 percentage points. Topical NSAIDs produced significantly greater relief for conjunctival itching (cardinal symptom) than did placebo (combined standardized mean difference -0.54 (p < 0.001; 95% confidence interval -0.84 to -0.24). The results for the other allergic symptoms: ocular burning/pain, eyelid swelling, photophobia and foreign sensation were not significant. Topical NSAIDs produced significantly greater reduction of conjunctival injection than did placebo (combined standardized mean difference -0.51 (p = 0.03; 95% confidence interval -0.97 to -0.05). Topical NSAIDs did not reduce the allergic signs of conjunctival chemosis, conjunctival mucus, eyelid swelling and corneal disturbance. Topical NSAIDs had a significantly higher rate of burning/stinging on application of medication compared to placebo (P < 0.0001; odds ratio 3.97 (95% CI 2.67 to 5.89).

CONCLUSION:

This meta-analysis confirms that topical NSAID are significantly more effective at relieving the cardinal symptom: conjunctival itching and improving the cardinal sign: conjunctival injection than placebo treatment. A systematic review comparing topical NSAIDs to topical antihistamines/mast cell stabilizers in treatment of allergic conjunctivitis is warranted as this will compare the topical NSAIDs to current therapeutic guidelines.

In spring, windblown dust storms originating in the deserts of Mongolia and China make their way to Taipei city. These occurrences are known as Asian dust storm (ADS) events. The objective of this study was to assess the possible associations of ADS with daily clinic visits for conjunctivitis in residents in Taipei, Taiwan, during the period from 1997-2001. Forty-nine dust storm episodes were classified and classified as index days. Daily clinical visits for conjunctivitis on the index days were compared with clinical visits on the comparison (non-storm) days. Two comparison days for each index day, 7 d before the index days and 7 d after the index days, were selected. The effects of dust storms on clinic visits for conjunctivitis were prominent 4 d after the event. However, the association was not statistically significant. There may not have been enough power to detect associations resulting from the inadequate sample size of conjunctivitis visits on ADS events days. However, it seems worthwhile to pay more attention to the ADS events and health in the future.

In the five year period between 1980 and 1984, 2146 adults and 172 neonates suffering from acute conjunctivitis underwent laboratory investigation for Chlamydia trachomatis (CT), Adenoviruses (AV), Herpes Simplex Virus (HSV) and pathogenic bacteria. Epidemiology and clinical features are presented and discussed. CT was detected in 29 per cent of neonates with conjunctivitis. 5.6 per cent of adults and older children investigated for follicular conjunctivitis were CT positive. There was a significant female preponderance among CT positive neonates of 1.9:1 (p less than 0.02). 91 per cent of neonates and 62 per cent of adults in whom CT was detected were receiving some sort of treatment. Serotypes 7, 3, 10, 4 and 8 were responsible in decreasing order of frequency for 96 per cent of AV infections. Serotype 7 was seen for the first time in an adult age distribution. HSV was isolated in 1.3 per cent of cases in the absence of typical lid or corneal lesions. Viral infection was not detected in any neonate. Bacterial infection was a more likely cause than CT in neonates if infection had persisted longer than 5 weeks (p much less than 0.001). Neonates with Staph aureus infection tended to present earlier in the course of disease than those with Haemophilus sp or Pneumococcus (p less than 0.05).

BACKGROUND:

Sublingual immunotherapy (SLIT) is a recognized and safe treatment for allergic rhinitis and conjunctivitis. The aim was to evaluate the efficacy and safety of tablets for grass and rye pollen- induced rhinitis and conjunctivitis.

METHODS:

A double-blind, randomized, placebo-controlled trial was carried out over 9 months. 105 patients received a standardized grass/rye mix extract or a placebo using sublingual drops during the build-up phase. Drops were replaced by sublingual tablets during the maintenance phase (300 IR/daily).

RESULTS:

In patients that received active treatment, a significantly lower total symptom score (rhinitis and conjunctivitis) compared to the placebo group was observed (p = 0.038). The investigators' assessment revealed a significant improvement in favor of the active treatment group (p = 0.018). Skin reactivity to grass and rye pollen was significantly reduced in the active treatment group (p < 0.05). No statistical difference was observed between the two groups for serum-specific IgG4 levels. Side effects were local and mild, and no severe systemic reactions were reported.

CONCLUSION:

This study indicates that tablet-based sublingual immunotherapy was safe and significantly improved grass/rye pollen-induced rhinoconjunctivitis symptoms. It was also associated with a significant inhibition of the immediate skin response.

CRD SUMMARY:

This review attempted to assess the diagnostic utility of signs, symptoms or both for the differential diagnosis of bacterial and viral conjunctivitis. The authors' conclusion that the use of signs and symptoms were not based on evidence accurately reflected the fact that no eligible studies were located, and appeared likely to be reliable.

During peak ragweed season, 86 patients with seasonal allergic conjunctivitis participated in a 9-week, multicenter, double-masked, placebo-controlled, group-comparative study testing the efficacy and safety of bid nedocromil sodium, 2% ophthalmic solution. The clinical effectiveness of nedocromil sodium was measured by analyzing the means of patient daily symptom scores and eye examinations after 1, 3, 5, and 8 weeks of treatment. The use of nedocromil sodium during peak ragweed pollen season reduced symptom scores with statistically significant treatment differences as compared with the placebo for itchy eyes, tearing, overall eye condition, and symptom summary score. Clinician assessments also favored the use of nedocromil sodium as indicated by significant improvements in tearing, conjunctival injection, and conjunctival edema. No significant side effects were reported by the patients, allergists, or ophthalmologists. We conclude that nedocromil sodium, 2% ophthalmic solution, administered bid is more effective in the relief of symptoms of seasonal allergic conjunctivitis than placebo and causes no major side effects.

OBJECTIVE:

To assess different management strategies for acute infective conjunctivitis.

DESIGN:

Open, factorial, randomised controlled trial.

SETTING:

30 general practices in southern England.

PARTICIPANTS:

307 adults and children with acute infective conjunctivitis.

INTERVENTION:

One of three antibiotic prescribing strategies-immediate antibiotics (chloramphenicol eye drops; n = 104), no antibiotics (controls; n = 94), or delayed antibiotics (n = 109); a patient information leaflet or not; and an eye swab or not.

MAIN OUTCOME MEASURES:

Severity of symptoms on days 1-3 after consultation, duration of symptoms, and belief in the effectiveness of antibiotics for eye infections.

RESULTS:

Prescribing strategies did not affect the severity of symptoms but duration of moderate symptoms was less with antibiotics: no antibiotics (controls) 4.8 days, immediate antibiotics 3.3 days (risk ratio 0.7, 95% confidence interval 0.6 to 0.8), delayed antibiotics 3.9 days (0.8, 0.7 to 0.9). Compared with no initial offer of antibiotics, antibiotic use was higher in the immediate antibiotic group: controls 30%, immediate antibiotics 99% (odds ratio 185.4, 23.9 to 1439.2), delayed antibiotics 53% (2.9, 1.4 to 5.7), as was belief in the effectiveness of antibiotics: controls 47%, immediate antibiotics 67% (odds ratio 2.4, 1.1 to 5.0), delayed antibiotics 55% (1.4, 0.7 to 3.0), and intention to reattend for eye infections: controls 40%, immediate antibiotics 68% (3.2, 1.6 to 6.4), delayed antibiotics 41% (1.0, 0.5 to 2.0). A patient information leaflet or eye swab had no effect on the main outcomes. Reattendance within two weeks was less in the delayed compared with immediate antibiotic group: 0.3 (0.1 to 1.0) v 0.7 (0.3 to 1.6).

CONCLUSIONS:

Delayed prescribing of antibiotics is probably the most appropriate strategy for managing acute conjunctivitis in primary care. It reduces antibiotic use, shows no evidence of medicalisation, provides similar duration and severity of symptoms to immediate prescribing, and reduces reattendance for eye infections.

TRIAL REGISTRATION:

Current Controlled Trials ISRCTN32956955 [controlled-trials.com].

In a randomised, multicentre study, the effect of azelastine eye drops (n = 51 patients) was compared in a double-blind manner with placebo eye drops (n = 30 patients) and in an open manner with levocabastine eye drops (n = 32 patients) during a 14-day treatment period involving 113 children (aged 4 to 12 years) suffering from seasonal allergic conjunctivitis/rhinoconjunctivitis. The primary variable was the response rate defined as the number of patients showing an improvement after three days of treatment of at least three score points, from a minimum baseline score of six, in the main ocular symptoms of itching, conjunctival redness and lacrimation (each assessed on a four-point scale). Patients discontinuing due to inefficacy were regarded as non-responders. The mean response rate in the azelastine eye drops group (74%) was significantly higher (p < 0.01) than that in the placebo group (39%) and comparable with that in the levocabastine group. The response rates assessed by the patients in their diaries were very similar. Significant differences (p < 0.01) for azelastine compared with placebo were observed on days 3 and 14 in the mean sum scores for the three main symptoms and for a total of eight eye symptoms. The overall assessment of efficacy confirmed the superiority of both active treatments compared with placebo. Adverse drug reactions were reported in 23% of placebo-, 35% of azelastine- and 38% of levocabastine-treated patients. These were mainly local irritant effects. Overall tolerability was assessed as very good or good in 80%, 84% and 91% of placebo-, azelastine- and levocabastine-treated patients, respectively. Azelastine eye drops are effective and well-tolerated in children with seasonal allergic conjunctivitis.

Background: Purulent bacterial conjunctivitis affects all ages with high frequency in newborns and children. In a subset of 150 children included in a large study having enrolled 1043 patients, our aim was to analyze in children, the efficacy and safety of azithromycin 1.5% eye-drops in the treatment of this disease. Methods: This multicenter, randomized, investigator-masked, parallel-group study, included 150 children and adolescents to study safety and compare azithromycin 1.5% eye drops twice daily for 3 days and tobramycin 0.3% 1 drop every 2 hours for 2 days then 4 times daily for 5 days. Out of 150 patients included, 58 had positive cultures and were studied for efficacy. Signs and symptoms were evaluated and cultures obtained at baseline, Days 3 and 9. Primary efficacy variable was the clinical cure (score 0 for bulbar conjunctival injection and purulent discharge) at the test of cure visit (day 9). Results: Both treatments were effective with a clinical and microbiologic cure of more than 80% of children on day 9. Azithromycin therapy provided a greater bacteriologic cure on day 3 than did tobramycin (P < 0.001) and eradicated bacteria that were defined as resistant, using classical antibiogram. No adverse effects were noted on the ocular surface. Conclusions: Azithromycin 1.5% eye drops leads to a rapid clinical and microbiological cure. © 2010 Lippincott Williams & Wilkins.

RECORD STATUS:

This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database.

CITATION:

CADTH. Olopatadine for the treatment of allergic conjunctivitis: a review of the clinical efficacy, safety, and cost-effectiveness. Ottawa: Canadian Agency for Drugs and Technologies in Health (CADTH). 2012