Trends in the Pharmacology of Inflammatory and Allergic Eye Disorders
Ocular allergies are one of the most common diseases presenting to the general ophthalmologist. Allergic eye disease includes a spectrum of different clinical entities: the seasonal and perennial allergic conjunctivitis and the more severe forms vernal keratoconjunctivitis and atopic keratoconjunctivitis. A wide spectrum of topical pharmacological agents has been developed for the treatment of the different forms of ocular allergy. These include mast cell stabilizers, pure antihistamines, new dual-acting agents with antihistamine and mast-cell stabilizer properties and non-steroidal antiinflammatory drugs (NSAIDs). All these drugs are very effective in controlling signs and symptoms of mild and moderate forms of allergic reaction and are mainly free of adverse reaction in the chronic use. Topical corticosteroids remain the mainstay in the aggressive treatment of sight-threatening forms of allergic conjunctivitis, although their long-term use is limited by the risk of severe ocular side effects. For this reason, newer immunosuppressive drugs, such as cyclosporine and tacrolimus, have been tested in the treatment of some forms of ocular allergy demonstrating an high safety profile. New potential therapeutic strategies include the modulation of the immune system through a switch of the allergic response from a Th2-dominated immune profile towards a Th1 response.
Keywords: Allergic conjunctivitis, topical ophthalmic therapy, antihistamine, corticosteroid, non-steroidal anti-inflammatory drugs, mast cell stabilizers, cyclosporine, tacrolimus
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