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  • David Chia, M.D. FACS

Over-the-counter Eye Allergy Itch Relief

An allergic response is an exaggerated or hypersensitive reaction of the immune system to a substance that is usually harmless to most people. This substance is known as an allergen. Allergic responses can manifest in various ways, depending on the type of exposure and the individual's immune system. Common allergens include pollen, dust mites, pet dander, certain foods, insect venom, and certain medications.


Allergic conjunctivitis is inflammation of the conjunctiva (the clear membrane that covers the white part of the eye and the inner surface of the eyelids) due to an allergic reaction.  Allergic conjunctivitis can cause symptoms such as itching, redness, tearing, and swelling of the eyes and eyelids.


There are several over-the-counter (OTC) products available for treating eye allergies, and they typically come in the form of eye drops or artificial tears. Some common ingredients found in these OTC eye allergy products include antihistamines, mast cell stabilizers, and decongestants. Here are some examples:

  1. Artificial Tears: (RECOMMENDED FOR MILD EYE ITCHING)

  • Preservative-Free Artificial Tears: These eye drops can help relieve dryness and irritation associated with allergies. They do not treat the underlying allergy but can provide symptomatic relief. However, using artificial tears to remove the offending allergen is generally safe and reasonable. We recommend using artificial tears as a first line agent for mild allergic conjunctivitis.

  1. Decongestant Eye Drops: (NOT RECOMMENDED)

  • Naphazoline (e.g., Naphcon-A, Clear Eyes): Decongestant eye drops can help reduce redness and swelling associated with eye allergies. These drops may temporarily relieve symptoms but are NOT recommended for regular use since they can damage the tear glands with repeated use.

  1. Mast Cell Stabilizer Eye Drops: (NOT RECOMMENDED)

  • Nedocromil (e.g., Alocril): This type of eye drop helps prevent the release of histamines and other substances that contribute to allergic reactions. Pure mast cell stabilizers unfortunately must be frequently dosed and also take many weeks to work.

  1. Antihistamine Eye Drops: (OK FOR MILD EYE ITCHING)

  • Ketotifen (e.g., Zaditor, Alaway): These eye drops provide relief from itching associated with allergic conjunctivitis. Ketotifen does usually work within minutes however. The main issues with Ketotifen is potency since it usually works in more mild cases of ocular itch and needs to be used at least twice a day.

  1. Antihistamine + Mast Cell Stabilizer Eye Drops: (OK FOR MODERATE TO SEVERE ALLERGIC CONJUNCTIVITIS)

  • Olopatadine (e.g., Pataday): Pataday is a brand name for an ophthalmic solution containing the active ingredient olopatadine. Olopatadine is a potent and selective histamine H1 receptor antagonist and mast cell stabilizer which is effective against signs and symptoms of allergic conjunctivitis. So Pataday works by not only by blocking the effects of histamine, a substance released during an allergic reaction, but also prevents the release of more histamine thereby greatly reducing the symptoms associated with allergic conjunctivitis.

It's important to note that Pataday is for topical use in the eyes and is not meant for oral ingestion. Pataday 0.1% and became over-the-counter through


In February 2020, the U.S. Food and Drug Administration originally approved Pataday Twice Daily Relief and Pataday Once Daily Relief for nonprescription, or over-the-counter (OTC), use through a process called a prescription (Rx)-to-OTC switch. The FDA approved Pataday Twice Daily Relief (olopatadine HCl ophthalmic solution/drops, 0.1%) for the temporary relief of itchy and red eyes due to pollen, ragweed, grass, animal hair or dander; and Pataday Once Daily Relief (olopatadine HCl ophthalmic solution/drops, 0.2%) for the temporary relief of itchy eyes due to pollen, ragweed, grass, animal hair or dander, for nonprescription use.


Later in July of 2020, the FDA approved Pataday Once Daily Relief Extra Strength (olopatadine 0.7%) as the first and only eye allergy itch drop offering a full 24 hours of relief without a prescription in the U.S. Pataday Once Daily Relief Extra Strength (olopatadine 0.7%), formerly prescribed as Pazeo®, became available in February 2021 nationwide. This move has greatly benefitted us all by providing us with a potent anti-allergy drop that is cost effective.


Remember, OTC Pataday Once Daily Relief Extra Strength (olopatadine 0.7%) is the same as prescription-only Pazeo® (olopatadine 0.7%). It is the same manufacturer, same ingredients, same concentration, same formulation = same product but different distribution channel. But beware the price difference! As you can see below, look at the price difference between Rx Pazeo (~$100/mL!) versus OTC Pataday Extra Strength (~$5/mL) as shown below:


GoodRx cost of Pazeo from Rite Aid, Pavilions and Vons as of Dec 2023 (CVS and Walgreens were more!)
CostCo price screenshot from December 2023

The comparison is even more ridiculous when you see that the CostCo price is for THREE bottles. So that the prescription is 20 TIMES more expensive than the OTC product. So you are almost ALWAYS better off buying Pataday Extra Strength WITHOUT insurance. Moreover, considering the cash only option is smart and reasonable not just for drugs but for office visits, imaging tests, and even many surgical procedures!


Of course, before using any OTC eye allergy product, it's essential to read and follow the instructions on the packaging. If you have any pre-existing eye conditions or are unsure about which product is suitable for you, it's advisable to consult with an eye care professional.





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