Clinical Optometry (Jul 2020)
Over-the-Counter Ocular Decongestants in the United States – Mechanisms of Action and Clinical Utility for Management of Ocular Redness
Abstract
Lester O Hosten,1 Christopher Snyder2 1Clinical and Medical Affairs, Bausch + Lomb, Bridgewater, NJ, USA; 2Regional Director Medical Science, Bausch + Lomb, Birmingham, AL, USACorrespondence: Lester O HostenClinical and Medical Affairs, Bausch + Lomb, 400 Somerset Corporate Boulevard, Bridgewater, NJ 08807, USATel +1 (908) 541-5449Email [email protected]: To manage ocular redness effectively, health-care practitioners require an understanding of the pathophysiology, clinical features and differential diagnosis of ocular redness, as well as comprehensive knowledge of medical therapies available and their pharmacologic properties. This review aims to provide a clinically relevant summary of the current literature on the mechanism of action, efficacy, and safety of current over-the-counter (OTC) decongestants available for reduction of ocular redness due to minor irritations. Currently marketed OTC products indicated for such use in the United States include topical solutions of tetrahydrozoline 0.05%, naphazoline 0.012% to 0.03%, and brimonidine 0.025%. All 3 agents are adrenergic receptor agonists but vary in their receptor-binding profiles: tetrahydrozoline is a selective α 1 receptor agonist; naphazoline is a mixed α 1/α 2 receptor agonist; and brimonidine is a selective α 2 receptor agonist. These OTC decongestants produce vasoconstriction of conjunctival blood vessels, which results in a rapid reduction in ocular redness. In general, ocular adverse events reported in published studies of these OTC decongestants were minimal, mild, and transient, with no significant adverse systemic effects. However, ocular decongestants with α 1-adrenergic receptor agonist activity can be associated with loss of effectiveness with continued use (ie, tachyphylaxis) and rebound redness upon treatment discontinuation. In clinical trials of the selective α 2-adrenergic receptor agonist brimonidine 0.025%, tachyphylaxis was not observed, and rebound redness was rarely reported.Keywords: brimonidine, naphazoline, ocular redness, ocular decongestant, over-the-counter, tetrahydrozoline
