Efficacy of lodoxamide
0.1% versus N-acetyl aspartylglutamic acid 6% ophthalmic solutions in patients with vernal keratoconjunctivitis.
sodium cromoglycate, nedocromil sodium, pemirolast, and lodoxamide
; (3) Dual acting agents - they have both antihistaminic and mast cell stabilizing properties, e.g., olopatadine, ketotifen, azelastine, and epinastine; (4) Non-steroidal anti-inflammatory drugs, e.g., ketorolac, diclofenac, and flurbiprofen; (5) Corticosteroids, e.g., prednisolone, hydrocortisone, fluorometholone, loteprednol, and desonide.
There are three drugs in this class that can be used topically in the eye: cromolyn, lodoxamide
(Alomide), and nedocromil (Alocril).
(1) Eleven trials that included 899 children and adults compared mast cell stabilizers (sodium cromoglycate, nedocromil, and lodoxamide
tromethamine) with placebo.
(6,43,44) However, the presence of limbal or corneal disease requires urgent referral--while patients await their appointment, pharmacyonly mast cell stabilisers may be advised such as sodium cromoglycate 2% and lodoxamide
0.1% (43,48) These two mast cell stabilisers are considered first-line ophthalmological therapy for VKC as they have been shown to be effective in several randomised controlled trials, can be used long-term and have excellent safety profiles.
A 47-year-old patient with symptoms of redness, blurred vision, burning, and watering in both eyes who was on topical lodoxamide
q12h, dexamethasone 0.1% q4h, and carboxymethylcellulose q4h had been referred to our clinic.
Mast cell stabilizers (lodoxamide
, nedocromil and pemirolast) are efficient in treatment of seasonal allergic rhinitis, but improvement of the symptoms takes a few days to a few weeks (61,62).
Topical mast cell stabilizers, such as lodoxamide
tromethamine 0.1% (Alomide[R]) and cromolyn sodium 4% (Crolom[R]), should be reserved for severe conditions (Wagner, 1997b).
Ocular mast cell stabilizing drugs such as lodoxamide
and cromolyn sodium can block the release of preformed mast cell mediators and reduce the generation of new inflammatory mediators, But these agents also require application 4-6 times per day, and the onset of action is slow Patients often need to use the drops for at least 1 week before experiencing the benefit.
Drugs, such as sodium cromoglycate, nedocromil sodium, pemirolast, and lodoxamide
act by stabilizing mast cells.
(13-16) The logic of such a treatment might be questioned since sodium cromoglicate is not considered to have any constitutive anti-inflammatory activity; the removal of the stimulus to inflammation should help and better results might be obtained with other mast cell stabilisers/anti-eosinophil drugs such as lodoxamide
or nedocromil sodium (both available to AS optometrists).
For chronic and recurrent allergic conjunctivitis, part of an appropriate management approach is the use of 'mast cell stabilisers', (21) with several drugs marketed in the UK (eg, sodium cromoglicate, lodoxamide
and nedocromil sodium).