Medication Summary
Medications currently used in the treatment of PCF include the following: topical artificial tears 4-8 times per day for 1-3 weeks, topical vasoconstrictor/antihistamine 4 times per day for severe itching, topical steroids for pseudomembranes and subepithelial infiltrates, and topical antibiotic to prevent bacterial superinfection. [5, 6]
Ocular lubricants
Class Summary
Used for symptomatic relief.
Artificial tears (Celluvisc, Murine, Artificial Tears, Tears Naturale, Refresh)
Acts to stabilize and thicken precorneal tear film and prolong tear film breakup time, which occurs with dry eye states. Preservative-free tear preparations may be particularly appropriate.
Antihistamines
Class Summary
For severe itching; these include first-generation antihistamines prescribed over the counter (eg, naphazoline), second-generation therapy with agents (eg, levocabastine [Livostin], lodoxamide [Alomide]), and third-generation drugs (eg, olopatadine [Patanol], nedocromil [Alocril], pemirolast [Alamast], ketotifen [Zaditor]). Third-generation drugs may have antihistamine, mast cell stabilizing, and cell-mediated immunity inhibitory effects.
Levocabastine (Livostin)
Potent histamine H1-receptor antagonist, for ophthalmic use.
Corticosteroids
Class Summary
Have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli. For pseudomembranes and subepithelial infiltrates, which cause glare and/or decreased vision.
Prednisolone ophthalmic (AK-Pred, Pred Forte)
Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.
In cases of bacterial infections, concomitant use of anti-infective agents is mandatory; if signs and symptoms do not improve after 2 days, reevaluate patient. Dosing may be reduced, but advise patients not to discontinue therapy prematurely.
Loteprednol etabonate (Lotemax, Alrex)
Unique retromolecular engineering design ester steroid is metabolized rapidly when unbound to glucocorticoid receptor. Decreased incidence of significant intraocular pressure elevations in FDA study protocols. Efficacy similar to dexamethasone and prednisolone.
Nonsteroidal anti-inflammatory agents (NSAIDs)
Class Summary
Have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action is not known but may inhibit cyclooxygenase activity and prostaglandin synthesis. Other mechanisms may exist as well, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell membrane functions.
Diclofenac ophthalmic (Voltaren)
Inhibits prostaglandin synthesis by decreasing activity of enzyme cyclooxygenase, which, in turn, decreases formation of prostaglandin precursors.
Ketorolac ophthalmic (Acular)
Potent prostaglandin inhibitor. Acular also is available in a preservative-free single-dose unit preparation at additional cost. Formulation is extremely useful in patients with ocular surface disease, including adenovirus infection, as well as in the perioperative period.
