Sodium Cromoglycate Eye Drops Research Articles

A clinical study to assess the efficacy of Triyushnadi Anjana in Kaphaja Abhishyanda with special reference to vernal keratoconjunctivitis

Vernal keratoconjunctivitis / spring catarrh is a variety of exogenous allergic conjunctivitis, which is a very troublesome ocular disease of childhood and in the adolescent age group. The child suffers from intense itching, grittiness, discharge, redness, lacrimation, photophobia, and so on, thereby, decreasing his learning hours. The troublesome features are aggravated in the spring season / hot climate that lasts for years together and rarely persists after adolescence. Mast cell stabilizers, topical Nonsteroidal anti-inflammatory drugs (NSAIDs), and steroids are the available treatment options that too with symptomatic relief and potential side effects, which limits the long-term use of these medicines. The clinical picture of vernal keratoconjunctivitis / spring catarrh is very similar to Kaphaja Abhishyanda, and Triyushnadi Anjana Bhaishajya Ratnavali (B.R.), and its treatment was clinically tried on the patients attending the Netra Roga OPD of the R.G. Government P.G. Ayurveda College Hospital at Paprola (H.P.). A proper protocol and performa was adopted with strict inclusion and exclusion criteria. In the first phase, a pilot study was conducted on 38 clinically diagnosed patients with vernal keratoconjunctivitis, and it gave 100% relief in photophobia, foreign body (FB) sensation, and lacrimation, with marked relief in other features. Encouraged by this pilot work, Triyushnadi Anjana (TA) and 2% sodium cromoglycate (mast cell stabilizer) eye drops in the second-phase clinical trial on 32 patients were tried clinically to evaluate the comparative efficacy. In the second clinical trial, the patients were randomly divided into two groups and Group I was given sodium cromoglycate 2% eye drops and Group II was given TA. The outcome of this study verified the results of the first phase pilot study, and on comparison of the results of the two groups in the second clinical study it was observed that the TA-treated group showed better results. Transient irritation in the eyes was reported by all patients after application of TA, which was relieved by keeping the eyes closed for a few minutes. None of the patients reported any adverse action of the trial drug. Thus, it can be concluded that TA is a safe, cost-effective, and potent Ayurvedic alternative in the treatment of vernal keratoconjunctivitis / spring catarrh.

The problem of allergy

One of the many areas of clinical practice in which GPs are accused of failing to keep up with modern methods is in the management of allergies. It seems that every couple of years some elite medical body documents the woeful state of standards in primary care and insists on the urgent need for more training for GPs as well as demanding the provision of more specialist services. So when patients ask for a referral for skin tests or other forms of expert investigation and treatment, I duly oblige. It is always something of an anticlimax when they return with a recommendation for a prescription for some combination of an antihistamine, a steroid cream, inhaler or nasal spray, and sodium cromoglycate eye drops. I used to …

Conjunctival Inclusion Cysts in Long-standing Chronic Vernal Keratoconjunctivitis

PurposeTo report a case of conjunctival inclusion cysts on the corneal limbus of a patient with chronic vernal keratoconjunctivitis during 16 months' follow up MethodsThe patient was a 26 year old male without any specific history of surgery or trauma. Giant papillae, shield ulcers, and Horner-Trantas dots were detected. During the 16 month follow-up, Sodium cromoglycate eye drops and Prednisolone acetate 1% eye drops were given 3 times a day. During this period, conjunctival cysts were detected on the corneal limbus in both eyes. In spite of improvement of the corneal and conjunctival conditions, the conjunctival cysts did not seem to show any specific changes. For relief of foreign body sensation, excision of the conjunctival cysts and giant papillae of the left eye and histopathologic examination of the specimen was performed. ResultsOn histopathological examination, the conjunctival cysts consisted of nonkeratinizing stratified epithelial cells filled with PAS-positive mucous substance. Inflammatory cells were not found in the vicinity.ConclusionsConjunctival inclusion cysts can be seen as an atypical finding of long-standing vernal keratoconjunctivitis. Mechanical friction between the giant papillae and conjunctiva may be a factor in inducing the formation of the conjunctival cysts.

Treating severe eye allergy.

Allergic eye conditions, particularly seasonal allergic conjunctivitis (SAC), are common. Itching, oedema and hyperaemia are relieved with topical H1-antagonists or sodium cromoglycate. The newer mast-cell stabilizing agent nedocromil sodium has a similar safety profile to sodium cromoglycate, but is more potent and has a more convenient twice-daily dosing regimen. When several placebo-controlled studies of its use in the treatment of SAC were analysed, it was found that 80% of patients reported symptom relief. In a further study, nedocromil sodium eyedrops (twice-daily dosing) had similar overall efficacy to sodium cromoglycate eyedrops (four-times-daily dosing) in subjects with SAC during the birch season, but during the period of highest pollen challenge, only the former agent was significantly more effective than placebo. Another study found that nedocromil sodium had efficacy equivalent to levocabastine over 7 days, but tended to have a more rapid onset of action. In patients with perennial allergic conjunctivitis (PAC) unresponsive to sodium cromoglycate, both clinicians and patients reported significantly better control of symptoms with nedocromil sodium eyedrops than with placebo. Recently, in a long-term study of treatment for vernal keratoconjunctivitis (VKC), it was found that nedocromil sodium 2% eyedrops produced a more rapid and marked improvement in symptoms than sodium cromoglycate 2% eyedrops and enabled lower use of steroid rescue medication. Both drugs were well tolerated and without serious side-effects.

Comparison of the efficacy and tolerability of topical levocabastine and sodium cromoglycate in the treatment of seasonal allergic rhinoconjunctivitis in children

Children (n = 110) with seasonal allergic rhinoconjunctivitis were randomized to receive either twice daily 0.05% levocabastine eye drops and nasal spray plus twice daily topical placebos or 2% sodium cromoglycate eye drops and nasal spray four times daily for a period of 4 weeks. Patients were required to use the nasal sprays as directed and the eye drops only when required. The results obtained suggest that topical levocabastine is at least as effective as sodium cromoglycate for the treatment of this condition. After 2 weeks treatment the effect of therapy on nasal symptoms was considered to be excellent or good in 72% of levocabastine-treated patients and 54% of patients on sodium cromoglycate (p = 0.009), with corresponding values for ocular symptoms of 81% and 57% in the two groups, respectively (p < 0.05). Investigator assessments also revealed that the severity of sneezing and lacrimation were significantly lower in the levocabastine group at this time (p < 0.05). After 4 weeks of treatment, patient diary data revealed that levocabastine was at least as effective as sodium cromoglycate with intergroup differences attaining statistical significance in favor of the topical antihistamine for nasal congestion (p < 0.05). Both agents were well-tolerated with no significant differences in the incidence or type of adverse reactions in the two treatment groups.

Sodium cromoglycate eye drops: Regular versus “as needed” use in the treatment of seasonal allergic conjunctivitis

Objective: The objective of this study was to compare the efficacy and side effects of sodium cromoglycate eye drops (Opticrom 2%) used regularly versus as needed in the treatment of seasonal (ragweed) allergic conjunctivitis. Methods: A randomized, unblinded, parallel group comparison was performed during the 6 weeks of the ragweed pollen season. Sixty-two adults with ragweed pollen–induced conjunctivitis were recruited for the study from previous ragweed studies and notices in the local media. Two drops of sodium cromoglycate were placed in each eye either four times daily (regular treatment group) or when needed, up to four times daily (prn group), from 1 week before and throughout the ragweed pollen season. Uncontrolled eye symptoms were treated with terfenadine 60 mg as needed, up to 120 mg daily. Subjects kept daily diaries for symptoms and medication requirements throughout the 6 weeks of treatment. The Rhinoconjunctivitis Quality of Life Questionnaire was administered and adverse experiences were reported after 1, 3, and 6 weeks of treatment. Results: Diary eye symptoms were similar in the two treatment groups, but quality of life was better in the regular treatment group. There was a trend for the prn group to require more terfenadine for uncontrolled eye symptoms. Conclusions: There may be some additional therapeutic benefit from using sodium cromoglycate eye drops regularly throughout the ragweed pollen season. (J ALLERGY CLIN IMMUNOL 1994;94:36-43.)

Studies comparing the efficacy of nedocromil sodium eye drops with sodium cromoglycate and placebo in seasonal allergic conjunctivitis

Two multicentre, double-blind, placebo controlled group comparative studies were carried out in Finland, during the birch pollen seasons of 1987 and 1989, to compare the efficacy and tolerability of 2% nedocromil sodium eye drops (twice daily) with either 2% sodium cromoglycate eye drops (four times daily) and/or placebo, in patients with seasonal allergic conjunctivitis. Study 1 compared nedocromil sodium (64 patients) with placebo (62 patients) and showed that the opinions of treatment efficacy of both patients and clinicians were significantly in favour of nedocromil sodium (p = 0.003, patients; p = 0.006, clinicians). In addition, the placebo group used significantly more topical (p<0.05) and oral (p<0.01) concomitant antihistamine therapy. Diary card scores and clinical assessments showed trends for active treatment. Study 2 compared nedocromil sodium (60 patients) with sodium cromoglycate (61) and placebo (64). Symptomatology was low, in general, but patient diary card scores showed significant control of itching by both active treatments. Clinical assessments also showed some improvement with both active treatments, reaching statistical significance for grittiness and photophobia. Overall opinions demonstrated a high placebo effect. At the end of the trial, full or moderate control of symptoms was reported by 80% of patients (73% clinicians) receiving nedocromil sodium, 75% of patients (74% clinicians) receiving sodium cromoglycate and 73% of patients (69% clinicians) receiving placebo. Taken as a whole, these results suggest that twice-daily nedocromil sodium eye drops are as efficacious as four times daily sodium cromoglycate eye drops in controlling seasonal allergic conjunctivitis.

Levocabastine compared with sodium cromoglygate eyedrops in children with both birch and grass pollen allergy

Fifty–five children 6–16 years old with allergic rhinoconjunctivitis due to both birch and grass pollinosis were randomized into 2 parallel groups, treated in double–blind fashion with either levocabastinc (LEV) eye–drops twice daily plus placebo eyedrops twice daily or sodium cromoglycate (SCG) eyedrops 4 times daily for 3 months. Spersallerg® (antazolini chloride + tetryzolini chloride) eyedrops were allowed as rescue medicine. All children received basic treatment with an antihistamine (terfenadine) during the complete trial period, and a local nasal corticosteroid if needed. Eye symptoms were recorded daily by the patients and at 4 visits by the investigator, at start and after 4, 10 and 13 weeks. Pollen counts were performed and a blood sample was collected at start and end of the treatment. The global evaluation of treatment was similar for the 2 groups, and there was no significant difference in any effect parameter except for the symptom, itchy eyes, which had lower score in the SCG group as evaluated by the investigator after 4 weeks. On days with low pollen counts the patients in the SCG group had fewer days with moderate or severe eye symptoms. It is concluded that even though LEV and SCG eyedrops were given in addition to systemic treatment with an antihistamine, no consistently significant differences in clinical effect were found between the 2 treatment groups, but the SCG group experienced slightly less eye symptoms throughout the trial. LEV eye–drops appear safe in long–term treatment in children, and no signs of tachyphylaxis were recorded.

New opticrom - same name, thicker eyedrops (▾?)

In May Fisons introduced a new formulation of sodium cromoglycate eyedrops (Opticrom) for use in allergic eye disease including hay fever. Until now the drops have been aqueous, and for use four times daily. The new viscous formulation, based on hypromellose (normally used four times daily as a tear substitute), is intended for twice daily use under the same name. The aqueous drops have been renamed ‘Opticrom Aqueou’; patients prescribed ‘Opticrom’ will get the new product unless the aqueous preparation is specified. Opticrom Aqueous has been difficult to obtain in some areas.

A comparison between 2% and 4% sodium cromoglycate eye drops in the treatment of vernal keratoconjunctivitis

Two per cent and 4% solutions of sodium cromoglycate eye drops were compared in patients with bilateral vernal keratoconjunctivitis. No difference in efficacy between the two solutions could be detected on the analysis of diary card scores or clinical assessments. The opinions of efficacy and treatment preferences recorded by patients and clinician at the end of the trial were very similar for each solution. Side effects were generally minor, usually relating to stinging following application of the eye drops.

Clinical trial with 2% sodium cromoglycate (Opticrom) in vernal keratoconjunctivitis.

An open assessment study was carried out during the summer of 1972 in which 2% sodium cromoglycate eyedrops were evaluated in the treatment of patients with vernal keratoconjunctivitis. A highly significant number of patients found the eyedrops effective, while a marked improvement was recorded in mild and moderate cases; in severe cases or in acute exacerbations additional steroid therapy was recommended. Sodium cromoglycate eyedrops were found to be as effective as Decadron and superior to Antistin-Privine. Furthermore SCG eyedrops could replace or reduce local steroid therapy in vernal keratoconjuntivitis and so avert the possible rise in ocular tension caused by steroids.