Olopatadine 0.1% Ranks as the Top Topical Treatment for Allergic Conjunctivitis

A study ranked olopatadine 0.1% and tacrolimus 0.1% as the greatest, most effective topical treatments for seasonal and perennial allergic conjunctivitis and vernal and atopic keratoconjunctivitis, respectively.1

“Newer antihistamines, particularly Olopatadine, are most effective for mild-moderate conditions, while immunomodulators, especially Tacrolimus, show superior efficacy in severe cases,” wrote investigators, led by Luksanaporn Krungkraipetch, from the department of ophthalmology at Burapha University, in Thailand.

Ocular allergies, such as seasonal allergic conjunctivitis, perennial allergic conjunctivitis, and vernal keratoconjunctivitis, affect approximately 20% of the global population and significantly hinder quality of life. Symptoms of ocular allergies include itchy eyes, redness, tearing, burning, clear, watery discharge, and corneal involvement.2

Ocular allergies pose high financial burdens, with medical costs in the US estimated to be $5.9 billion annually. Treatment options for ocular allergies include antihistamines, mast cell stabilizers, corticosteroids, and immunomodulators.1 Although meta-analyses have evaluated individual treatment comparisons, investigators recognized the lack of comprehensive evaluation of all available interventions for ocular allergies—and the nonexistence of guidelines from the American Academy of Ophthalmology for this disease.

Thus, investigators conducted a systematic review and a network meta-analysis to evaluate and rank the effectiveness of topical treatments for various types of ocular allergies. They searched PubMed, Cochrane CENTRAL, Google Scholar, and Scopus databases and selected 28 randomized controlled trials published between January 2000 and December 2025 that assessed topical treatments for ocular allergies. Studies included examined antihistamines, corticosteroids, immunomodulators, and combination therapies.

The team analyzed the data following PRISMA guidelines and made direct and indirect comparisons between topical treatments. Primary outcomes included reduction in ocular itching, redness, and inflammation.

The study identified olopatadine 0.1% as the most effective in treating seasonal and perennial allergic conjunctivitis, with surface under the cumulative ranking curve (SUCRA) scores of 0.88 and 0.85, respectively. Moreover, tacrolimus 0.1% demonstrated the greatest effectiveness in vernal and atopic keratoconjunctivitis, reflected by SUCRA scores of 0.92 and 0.89, respectively.

Investigators found overall treatment effect was significant (odds ratio [OR], 6.95; 95% confidence interval [CI], 6.24 – 7.75) with moderate heterogeneity (I2 = 50.8%).

“The findings offer valuable insights into the relative effectiveness of antihistamines, mast cell stabilizers, corticosteroids, immunomodulators, and combination therapies,” investigators wrote.

The subgroup analysis showed consistent efficacy across different types of allergic conjunctivitis, though seasonal allergic conjunctivitis demonstrated the greatest cumulative ranking probability (89.0%).

“This network meta-analysis provides strong evidence supporting condition-specific treatment approaches in ocular allergies,” investigators concluded. “These findings provide clear evidence-based hierarchies for clinical decision-making in the management of different types of allergic conjunctivitis.”

References

1. Krungkraipetch L, Tansavadi T, Krungkraipetch D. Ranking the Efficacy of Topical Treatments for Ocular Allergy: A Network Meta-Analysis of Current Evidence. Ocul Surf. Published online May 8, 2025. doi:10.1016/j.jtos.2025.05.003

2. Eye Allergy. ACAAI. https://acaai.org/allergies/allergic-conditions/eye-allergy/. Accessed May 14, 2025.