Allergy Eye Drops: Which Ones Work and How to Choose

For itchy eyes from allergies, look for an eye drop that contains an antihistamine. Olopatadine (Pataday), ketotifen (Zaditor, Alaway) and alcaftadine (Lastacaft) are sold over the counter, and their labels say they temporarily relieve itchy eyes due to pollen, ragweed, grass, animal hair and dander. If drugstore drops don't settle your symptoms, or they get worse over time, an optometrist can talk with you about prescription drops. Stop an over-the-counter allergy drop and ask a doctor if redness increases or the itching worsens or lasts more than 72 hours. Eye pain or a change in vision needs a same-day exam (call 310-828-2010), or an emergency room when we're closed; sudden vision loss means calling 911. Our eye allergies page explains the condition itself.

Key takeaways

Choose a drop whose active ingredient is an antihistamine, such as olopatadine, ketotifen or alcaftadine, which are sold over the counter for temporary itch relief.
Take contact lenses out before using olopatadine or alcaftadine, and wait at least 10 minutes before you put them back in.
If itching worsens or lasts more than 72 hours, or redness increases, stop the over-the-counter drop and ask a doctor.
Eye pain or a change in vision needs a same-day exam, or an emergency room when we're closed, and sudden vision loss, even if it comes back, means calling 911.

What are eye allergy symptoms?

Eye allergies cause itching, redness and swelling, in one eye or both. When an allergy inflames the inside of the eyelid and the white of the eye, it's called allergic pink eye, or allergic conjunctivitis. It usually affects both eyes. The eyes can be teary and swollen, the itching can be intense, and an itchy nose, sneezing, a scratchy throat or asthma may come with it.

Seasonal and year-round (perennial) allergic conjunctivitis together make up 95% of allergic conjunctivitis in the U.S. Pollen drives the seasonal kind: trees, weeds and grasses release it each spring, summer and fall. Dust mites, mold spores and pet dander are other common allergens.

Itchy eyes aren't always allergy. Dry eye and blepharitis can feel much the same, which is why diagnosis takes a comprehensive eye exam. Blepharitis is inflammation that makes the eyelids red, swollen, irritated and itchy. Contact lenses can also cause a long-lasting allergic reaction. Our pages on dry eye and blepharitis cover those causes.

What kinds of allergy eye drops are there?

Allergy eye drops come in a few types, and the label tells you which one you're holding. On an over-the-counter box, the Drug Facts give a purpose for each active ingredient. In a combination drop, for example, pheniramine is listed as the antihistamine and naphazoline as the redness reliever.

Type	Examples (active ingredient)	How it's sold	What the label says it's for
Antihistamine	Pataday Once Daily Relief (olopatadine 0.2%), Zaditor and Alaway (ketotifen 0.025%), Lastacaft (alcaftadine 0.25%)	Over the counter	Temporary relief of itchy eyes due to pollen, ragweed, grass, animal hair and dander
Antihistamine plus redness reliever	Visine Allergy Eye Relief Multi-Action (pheniramine 0.3% and naphazoline 0.025%)	Over the counter	Temporary relief of itchy, red eyes due to pollen, ragweed, grass, animal hair and dander
Antihistamine	Bepreve (bepotastine), Zerviate (cetirizine)	Prescription	Itching associated with allergic conjunctivitis
Mast cell stabilizer	Cromolyn sodium 4%	Prescription	Vernal keratoconjunctivitis, vernal conjunctivitis and vernal keratitis
Steroid	Alrex (loteprednol etabonate 0.2%)	Prescription	Temporary relief of the signs and symptoms of seasonal allergic conjunctivitis

Table sources: the DailyMed labels for Pataday Once Daily Relief, Zaditor, Alaway, Lastacaft, Visine Allergy Eye Relief Multi-Action, Bepreve, Zerviate, cromolyn sodium and Alrex.

We name brands only as examples. The active ingredient on the box is what to compare.

How do antihistamine and mast cell stabilizer drops work?

Both act on histamine, a chemical that immune cells called mast cells release when they meet something you're allergic to. Antihistamine drops block histamine at its H1 receptor; cetirizine's label, for example, calls it a histamine-1 (H1) receptor antagonist.

Mast cell stabilizers work a step earlier, by keeping mast cells from releasing histamine. Cromolyn has no antihistamine activity of its own, and its label says relief from itching, tearing, redness and discharge usually shows within a few days, though treatment for up to six weeks is sometimes needed. It's approved for vernal keratoconjunctivitis and two related conditions. Vernal keratoconjunctivitis is a rare, severe allergic reaction that keeps coming back and affects the cornea (the clear front of the eye) and the lining over the white of the eye, most often in young boys.

Some drops do both jobs. Bepotastine's label and alcaftadine's older prescription label (alcaftadine is now sold over the counter) describe each one as an H1 receptor antagonist and an inhibitor of the release of histamine from mast cells.

Which allergy eye drops can you buy without a prescription?

Three antihistamines are sold over the counter as single-ingredient eye drops: olopatadine, ketotifen and alcaftadine. Their labels give the same use, temporary relief of itchy eyes due to pollen, ragweed, grass, animal hair and dander. Use them as the label directs.

Check the age on the box. The olopatadine and alcaftadine labels say to consult a doctor for children under 2, and the ketotifen directions start at age 3. A child who rubs itchy eyes all the time should have an exam; see pediatric eye exams.

Combination drops add a redness reliever to an antihistamine. Visine Allergy Eye Relief Multi-Action pairs pheniramine with naphazoline, and its label carries cautions the plain antihistamine drops don't:

Ask a doctor before use if you have heart disease, high blood pressure, narrow angle glaucoma or trouble urinating. If you've been told you have narrow angles, ask your eye doctor before you use a drop with a redness reliever. Sudden intense eye pain with nausea, a red eye or blurry vision can be angle-closure glaucoma, a medical emergency: call us right away at 310-828-2010, or go to an emergency room when we're closed.
Your pupils may become enlarged for a while, which can make you sensitive to light.
Overuse may cause more eye redness.
Children under 6 need a doctor's advice, and accidental swallowing by infants and children may lead to coma and a marked drop in body temperature. Store it out of reach, and if a child swallows any, get medical help or call Poison Control at 1-800-222-1222 right away.

Can you use allergy eye drops with contact lenses?

Yes, if you take your lenses out first and follow the label. The over-the-counter olopatadine and alcaftadine labels say to remove contact lenses before use, wait at least 10 minutes before putting them back in, and not wear a contact lens if your eye is red.

The olopatadine and ketotifen labels also say not to use these drops to treat contact lens related irritation. Contact lenses can be a chronic cause of eye allergy, so itching that shows up mainly with lenses in deserves a closer look. Our page on contact lens discomfort covers the usual reasons.

If an eye is painful, red, blurry or sensitive to light while you wear lenses, or you see a white spot on it, take the lenses out and call us right away at 310-828-2010 for a same-day exam, or go to an emergency room when we're closed.

Cromolyn is stricter. Its label says not to wear contact lenses at all during treatment.

When do eye allergies need prescription treatment?

If over-the-counter drops aren't relieving your symptoms, or they're getting worse over time, see an optometrist about prescription drops or oral medication.

Prescription antihistamine drops include bepotastine (Bepreve), labeled for itching associated with allergic conjunctivitis, and cetirizine (Zerviate), labeled for ocular itching associated with allergic conjunctivitis in adults and children 2 and older. In Bepreve's studies, the most common side effect was a mild taste after the drop went in, in about 25% of patients.

Loteprednol 0.2% (Alrex), a steroid drop, is labeled for the temporary relief of the signs and symptoms of seasonal allergic conjunctivitis. Its label warns that prolonged use of corticosteroids may result in glaucoma with damage to the optic nerve, in cataract formation and in a higher risk of eye infections, and that eye pressure should be monitored if it's used for 10 days or longer.

When do allergy symptoms need a doctor instead of drugstore drops?

Stop an over-the-counter allergy drop and ask a doctor if you have eye pain, changes in vision or increased redness, or if the itching worsens or lasts more than 72 hours.

See a doctor, too, if a red eye comes with eye pain, sensitivity to light, blurred vision that doesn't improve when discharge is wiped away, intense redness, or symptoms that get worse or don't improve. During office hours (Monday 10 to 5, Tuesday through Friday 8 to 5) we see painful or light-sensitive eyes the same day: call 310-828-2010 or read about urgent eye care. When we're closed, evenings and weekends, go to an emergency room instead.

Loss of sight in one or both eyes can be a sign of stroke, so if your vision goes suddenly, call 911, even if it comes back. Call 911 for a serious allergic reaction, too, such as swelling of the lips or tongue, throat tightness or trouble swallowing, or shortness of breath or wheezing.

How we treat eye allergies at Cohenmehr Optometry

At Cohenmehr Optometry, we start by making sure it's allergy. At the slit lamp we examine the lids, the tear film and the surface of the eye under magnification, since dry eye and blepharitis can look a lot like allergies.

Treatment follows what we find:

Prescription-strength allergy drops, matched to the problem
Cool compresses and preservative-free artificial tears to wash allergens off the surface of the eye
Trigger control at home: filters, bedding, and washing your hands and face after time outdoors
Treatment for dry eye when it's part of the picture, through our dry eye program

When a child rubs itchy eyes constantly, we also examine the cornea, because allergy, rubbing and keratoconus travel together. Our page on eye rubbing and keratoconus explains the link.

Questions patients ask

What are the best allergy eye drops?

No single drop suits everyone; the right one depends on your symptoms, your age and whether you wear contact lenses. For itchy eyes, look for a drop whose label lists an antihistamine, such as olopatadine, ketotifen or alcaftadine. The American Optometric Association lists over-the-counter allergy eye drops as a first treatment, and suggests seeing an optometrist about prescription drops or oral medication if symptoms don't subside or get worse.

How do you deal with eye allergies?

Limit contact with what sets them off, and treat the symptoms. Pink eye caused by an allergen, such as pollen or animal dander, usually improves once the allergen is removed from your surroundings. Cold compresses and artificial tears help relieve inflammation and dryness, and allergy medicines and certain eye drops, including some prescription drops, can also bring relief. Your doctor may recommend a combination.

How do you stop a runny nose and watery eyes fast?

If allergies are behind both, treat the allergy. Pollen can trigger hay fever, which brings sneezing with a runny or clogged nose along with itching and red, watery eyes. Medicines and nasal sprays can relieve the symptoms, and you can rinse your nose with saline made with distilled or sterilized water. Allergy shots can make you less sensitive to pollen and give long-term relief. For the eyes themselves, an over-the-counter antihistamine eye drop temporarily relieves the itch.

Is it bad to use allergy eye drops every day?

Not when it's the right drop, used as directed. The American Optometric Association recommends using allergy medicines before and during allergy season to prevent symptoms. Two kinds need more care: combination drops with a redness reliever, whose label warns that overuse may cause more eye redness, and steroid drops, which call for eye pressure checks when they're used for 10 days or longer.

Sources

Written by

Dr. Bijan Cohenmehr, OD

Founder of Cohenmehr Optometry, in practice for over 40 years. He leads the practice’s dry eye care and myopia management. A graduate of SUNY College of Optometry.

About Dr. Bijan →

Which Allergy Eye Drops Work, and How Do You Choose One?