chronic

Allergic conjunctivitis

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources5 sources

AAO Preferred Practice Pattern: Conjunctivitis 2018 · Opatanol 1 mg/ml eye drops SmPC sections 4.2 and 4.4 (eMC product 6768) · eMC SmPC, Zaditen 0.25 mg/ml eye drops solution (Thea Pharmaceuticals), sections 4.1 and 4.2 · Allergic Conjunctivitis - disease-level clinical article (allergic-conjunctivitis-clinical.txt) · Egyptian National Drug Formulary - Respiratory System 2026 (loratadine monograph)

Verified against4 documents

Opatanol 1 mg/ml eye drops SmPC sections 4.2 and 4.4 (eMC product 6768)
eMC SmPC, Zaditen 0.25 mg/ml eye drops solution (Thea Pharmaceuticals), sections 4.1 and 4.2
Allergic Conjunctivitis - disease-level clinical article (allergic-conjunctivitis-clinical.txt)
Egyptian National Drug Formulary - Respiratory System 2026 (loratadine monograph)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (8)

Itching along with widespread redness of the white and inner-lid surface of the eye is the most typical complaint [itching · redness]
A clear, watery discharge affecting both eyes, with mild morning crusting, marks the simple form [crusting]
Pain or blurred vision is not typical of the simple form and should raise suspicion of another diagnosis [blurred vision]
Episodes often come with sneezing and a runny nose, the usual companions of allergic rhinitis [allergic rhinitis · runny nose · sneezing]
The vernal form flares worst in spring, with thick mucus, pain, light sensitivity, and blurred vision [blurred vision · photophobia]
A foreign-body sensation with frequent blinking is typical of the vernal form [foreign body]
The atopic form tends to be year-round, with pain, blurred vision, light sensitivity, and a foreign-body feeling [blurred vision · foreign body · photophobia]
Worsening itch and a switch from watery to thick mucus discharge signal progression to the papillary form, often tied to contact lens wear [itching]

Signs — what you find (8)

Pronounced eyelid swelling and chemosis (conjunctival swelling) are common in the simple form [eyelid swelling]
Giant papillae on the upper tarsal conjunctiva are a universal exam finding in the vernal form
Flat-topped, cobblestone-like macropapillae under 1 mm appear early in the palpebral vernal form
White cellular deposits at the limbus, Horner-Trantas dots, are a hallmark of the limbal vernal form
Superior punctate corneal erosions with mucus are typical of vernal keratopathy [corneal changes]
Absent outer eyebrows (Hertoghe sign) and lower-lid skin creases (Dennie-Morgan folds) are seen in the atopic form
In the atopic form the lower lid conjunctiva is affected more than the upper, the reverse of the vernal pattern
Contact-lens papillary disease shows mobile, protein-coated lenses and hyperemia of the upper tarsal conjunctiva with papillae

Tests (4)

Fluorescein staining can rule out a corneal abrasion when that is a concern
Skin-prick or blood allergy testing can pin down the specific triggers when needed
Scraping the conjunctiva and finding eosinophils supports the diagnosis in the simple form, though skin testing is rarely required
Abundant eosinophils on conjunctival scraping are typical of the vernal form

If not this — what else fits (5)

Viral or bacterial conjunctivitis needs to be distinguished from the allergic type
Trachoma and chlamydial or neonatal conjunctivitis are infectious look-alikes
Nonallergic eosinophilic conjunctivitis and contact allergic blepharoconjunctivitis mimic the allergic picture
Severe blistering conditions such as mucous membrane pemphigoid or Stevens-Johnson syndrome belong on the differential
Superior limbic keratoconjunctivitis is another differential to consider

SourceStatPearls "Allergic Conjunctivitis" - disease-level clinical article

Presentation findings are traced to the source above.

OLOPATADINE

1st line

Formeye

Adult dose and duration

1 drop into the affected eye(s) twice daily, 8 hours apart - as required

Paediatric dose

Age restriction: minimum 36 months

(Children >3 years: 1 drop twice daily into affected eye(s))

Dose by age
Over 3 years:	1 drop into affected eye twice daily.

Dose source

Opatanol 1 mg/ml eye drops SmPC sections 4.2 and 4.4 (eMC product 6768)

Why

Combines direct antihistamine blockade with mast cell stabilization, calming the immediate itching and redness of allergic conjunctivitis while also reducing further histamine release on continued allergen exposure.

Cautions

Soft contact lenses take up the preservative and discolour: out before the drop, back in no sooner than 15 minutes after.
Transient burning or stinging may occur upon drop instillation.
Licensed from 3 years at the adult dose, and may be continued up to four months where needed.
Olopatadine has dual antihistamine and mast cell stabilizer action.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
PATADOLINE 0.1% EYE DROPS 5 ML	GLOBAL ADVANCED PHARMACEUTICALS (GAP)	38.00 EGP

KETOTIFEN

1st line

Formeye

Adult dose and duration

One drop of 0.25 mg/mL solution into the conjunctival sac of the affected eye(s) twice daily - Through the allergen season; the SmPC sets no maximum duration

Paediatric dose

(Children aged 3 years and over: the same regimen as adults, one drop twice daily. Safety and efficacy below 3 years have not been established. No mg/kg dosing applies to eye drops.)

Dose by age
3 years and over:	One drop twice daily, the same regimen as adults

Choice

Alternatives. Availability decides: 6 Egyptian ketotifen products from 6 EGP against a single olopatadine product at 38.

Dose source

eMC SmPC, Zaditen 0.25 mg/ml eye drops solution (Thea Pharmaceuticals), sections 4.1 and 4.2

Why

22 live products, and Egyptian ketotifen is sold in both oral and eye-drop form. The SmPC indication is symptomatic treatment of seasonal allergic conjunctivitis, which is this condition exactly, and the row currently holds only olopatadine.

Cautions

Remove soft contact lenses before instilling and wait at least 15 minutes before reinserting - the benzalkonium chloride is absorbed by the lens material and discolours it.
Each drop contains 2.6 micrograms of benzalkonium chloride, which can irritate a dry or damaged cornea.
Transient blurring and drowsiness after instillation - do not drive until vision has cleared.
Leave at least 5 minutes between this and any other eye drop.
Pain, photophobia or reduced vision is not allergic conjunctivitis - refer.
There are also oral ketotifen products in Egypt with the same generic name; those are a different treatment at a different dose and are sedating.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
PROPHALLERGE 0.025% EYE DROPS 5 ML	RAMEDA	6.50 EGP
TOTISWIX 0.025% EYE DROPS 5 ML	CHEMIPHARM	7.00 EGP
REDNOTT 0.25MG/ML EYE DROPS 5 ML	RAMEDA > PHAROPHARMA	12.00 EGP
ZADITEN 0.025% EYE DROPS 5 ML	EXCELVISION > NOVARTIS	28.80 EGP
ORCHAZID 0.025% EYE DPS. 10 ML	ORCHIDIA PHARMACEUTICAL INDUSTRIES > ORCHIDIA	31.00 EGP
ORCHAZID 0.025% EYE DROPS 30*0.4 ML SDU	ORCHIDIA PHARMACEUTICAL INDUSTRIES > ORCHIDIA	60.00 EGP

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line

Dose source

Allergic Conjunctivitis - disease-level clinical article (allergic-conjunctivitis-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions

RED FLAG - Pain and decreased visual acuity are not typical of simple allergic conjunctivitis; their presence should raise suspicion of an alternative (more serious) diagnosis rather than being treated as ordinary allergic conjunctivitis.

LORATADINE

add-on - not a substitute

Strength10 mg

Formoral.solid

Adult dose and duration

10 mg once daily - as-needed

Paediatric dose

Age restriction: minimum 24 months

(ENDF: 10 mg once daily from 6 years; 5 mg once daily from 2 to 6 years. By weight in children under 12: 5 mg once daily at 30 kg or less, 10 mg once daily above 30 kg.)

Dose by age
2 to under 6 years:	5 mg once daily
6 years and over:	10 mg once daily

Dose source

Egyptian National Drug Formulary - Respiratory System 2026 (loratadine monograph)

Why

The disease article calls for an oral antihistamine in severe symptoms and prefers loratadine over diphenhydramine for its lower sedation.

Cautions

Children under 2 years of age: safety and efficacy have not been established, no data are available.
CrCl under 30 mL/minute: 10 mg every 48 hours
Severe liver impairment: 10 mg every other day in adults and children over 30 kg, 5 mg every other day at 30 kg or less

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
HISTALONG 10 MG 20 TAB.	JEDCO INT. CO. FOR PHARMACEUTICALS	17.00 EGP (0.85/unit)
UNILORATADINE 10 MG 20 TABS.	UNIPHARMA CO. > UNIPHARMA	17.00 EGP (0.85/unit)
SEDCLARIT 10MG 20 TAB.	SEDICO	19.50 EGP (0.97/unit)
LORATADINE 10MG 10 TAB.	MISR	25.50 EGP (2.55/unit)
ONY 10 MG 20 TABS.	UNIPHARMA	51.00 EGP (2.55/unit)
ALLERGETONE 10 MG 20 TABS.	MARCYRL PHARMACEUTICAL INDUSTRIES (MPI) > SPLENDID PHARMA	66.00 EGP (3.30/unit)
CLARITINE 10MG 20 TAB.	SEDICO > BAYER HEALTHCARE	110.00 EGP (5.50/unit)
ALLERGIRAZ 10MG 30 DISINTEGRATING TABS.	JEDCO INT. CO. FOR PHARMACEUTICALS > ELRAZY PHARMACEUTICALS-EGYPT	31.50 EGP
LORANO 5MG/5ML SYRUP 60ML? strength differs? different route - not oral solid	MINA PHARM	5.00 EGP
UNILORATADINE 5MG/5ML SYRUP 100 ML? strength differs? different route - not oral solid	UNIPHARMA CO. > UNIPHARMA	9.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.