Which allergy drops are preferred in pregnancy?

Pregnancy guidance varies and can change. Use the lowest effective dose for the shortest duration, verify current labeling, and coordinate with the patient’s OB provider when needed.

OTC versus prescription allergy drops: is there a real difference?

Often the clinical effect is similar. The practical differences are cost, coverage, and access to specific formulations. Prescription options help when OTC therapy is inadequate or formulary coverage favors a particular agent.

How long should patients try a dual-action drop before judging failure?

Itch relief can be rapid, but control improves with consistent use. A common approach is a 1 to 2 week trial of regular dosing before declaring failure, then reassess and escalate if needed.

Allergy Eye Drops

Dual-action, antihistamine, and mast cell stabilizer drops for allergic conjunctivitis

Allergy Eye Drops: Stepwise Treatment for Allergic Conjunctivitis

What these medications target

Most routine ocular allergy (seasonal or perennial allergic conjunctivitis) is driven by IgE-mediated mast cell activation. The hallmark symptom is itching, with chemosis and redness largely mediated by histamine and related inflammatory mediators. Treatment focuses on two practical targets:

Antihistamine effect (H1 blockade): Rapid itch relief and reduction in chemosis and redness.
Mast cell stabilization: Fewer flare-ups with continued exposure, with benefit building over days to weeks.

The tables on this page compare common agents by class, typical dosing patterns, and key cautions so you can match a drop to the patient's symptom pattern, ocular surface status, and contact lens habits.

First-line therapy: dual-action antihistamine and mast cell stabilizers

For uncomplicated allergic conjunctivitis, dual-action drops are usually first-line because they provide quick itch relief while also improving control with continued use. Examples include olopatadine, ketotifen, alcaftadine, and bepotastine.

In practice, selection is often driven by dosing convenience (once versus twice daily), preservative exposure in frequent users, and cost and coverage. If symptoms remain uncontrolled, escalation is often more effective than cycling through multiple similar agents without a clear plan.

When to add a steroid

In more severe disease, dual-action drops may not be enough for the acute phase. Examples include marked papillary responses, significant contact lens-related giant papillary conjunctivitis (GPC), and vernal keratoconjunctivitis. In these settings, a short, closely monitored course of a lower-risk topical steroid, often loteprednol formulations, can reduce inflammation so maintenance therapy becomes effective. Steroids should be tapered as signs improve and paired with IOP monitoring and appropriate follow-up.

Contact lenses and preservative exposure

Many multi-dose allergy drops contain preservatives, commonly BAK, which can worsen surface irritation with frequent use and can bind to soft contact lenses. Standard counseling is to remove lenses, instill the drop, and wait 10 to 15 minutes before reinsertion unless the product is specifically labeled for in-lens use. If a patient needs frequent dosing or has significant surface disease, consider strategies that reduce preservative burden and temporarily reduce lens wear during flares.

Step-up options when symptoms persist

If symptoms remain significant despite appropriate dual-action therapy, reassess the diagnosis and contributing factors such as dry eye, blepharitis, and ongoing allergen exposure. Step-up options can include short-term steroid rescue, adding supportive measures such as cool compresses and preservative-limited lubrication, and addressing contact lens wear and replacement schedules during flares.

Allergy Eye Drops

Brand	Generic	Dosing	Amount	Ages	Pregnancy	Mechanism
Alaway GenericOTC	ketotifen 0.025%B+L 0.035%	bid	10mL	>3 years	C	antihistaminemast cell stabilizer
Bepreve Generic	bepotastine besilate 1.5%	bid	5/10mL	>2 years	C	antihistaminemast cell stabilizer
Elestat Generic	epinastine 0.05%	bid	5mL	>2 years	C	antihistaminemast cell stabilizer
Lastacaft GenericOTC	alcaftadine 0.25%	qd	3mL	>2 years	B	antihistaminemast cell stabilizer
Opcon-A GenericOTC	naphazoline 0.25%pheniramine maleate 0.3%	qd-qid	15mL	>6 years	C	antihistaminevasoconstrictor
Optivar Generic	azelastine 0.05%	bid	6mL	>3 years	C	antihistaminemast cell stabilizer
Pataday Once Daily Relief GenericOTC	olopatadine 0.2%0.7% (Extra Strength)	qd	2.5mL	>2 years	C	antihistaminemast cell stabilizer
Pataday Twice Daily Relief GenericOTC	olopatadine 0.1%	bid	5mL	>2 years	C	antihistaminemast cell stabilizer
Zaditor GenericOTC	ketotifen 0.025%	bid	5mL	>3 years	C	antihistaminemast cell stabilizer
Zerviate Generic	cetirizine 0.24%	bid	5mL30 vials/carton	>2 years	NA	antihistaminemast cell stabilizer

Ocular Allergy Medication FAQs

Can allergy drops be used in contact lens wearers?: Often yes, but most multi-dose allergy drops contain preservatives that can bind to soft lenses and increase irritation. A practical rule is to remove lenses, instill the drop, and wait 10 to 15 minutes before reinsertion unless the product is explicitly labeled for use with contact lenses. During active flares with significant redness, discomfort, or papillary change, temporarily reducing lens wear is often the safer and more comfortable choice.
Which allergy drops are preferred in pregnancy?: Pregnancy safety data for ophthalmic allergy drops can be limited, and recommendations may change as labeling updates. When treating a pregnant patient, use the lowest effective dose for the shortest reasonable duration, review current prescribing information, and coordinate with the patient's obstetric provider, especially if symptoms are severe or prolonged therapy is anticipated.
OTC versus prescription allergy drops: is there a real difference?: Many effective dual-action drops are available over the counter, and symptom relief is often similar whether obtained OTC or by prescription. Practical differences are usually cost, coverage, and access to specific formulations. A prescription option can be useful when symptoms remain uncontrolled, when formulary coverage favors a specific agent, or when you want structured follow-up tied to disease severity and contact lens wear.
How long should patients try a dual-action drop before judging failure?: Many patients notice itch relief quickly, but mast cell stabilization provides better control with consistent use over time. A reasonable trial is often 1 to 2 weeks of regular dosing, assuming the patient is avoiding triggers as much as practical and is using proper contact lens timing. If symptoms are not improving, reassess the diagnosis and consider step-up therapy rather than simply switching among similar drops repeatedly.