Water from eye with itching prescribe eye drop

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Based on authoritative ophthalmology references, here is the clinical approach:

Watery Eye with Itching - Allergic Conjunctivitis

Presentation: Bilateral itching, watery/thin discharge, red eyes, eyelid edema, chemosis, no preauricular lymph node - this is the classic picture of allergic conjunctivitis.

Eye Drop Prescriptions (by Severity)

Mild

Drop	Dose
Artificial tears (lubricant)	4-8 times/day

Moderate (first-line Rx)

Dual-acting Antihistamine + Mast Cell Stabilizer drops - these are the preferred first choice:

Drug	Strength	Dose
Olopatadine (Pataday)	0.2% or 0.7%	1 drop OD (once daily)
Alcaftadine (Lastacaft)	0.25%	1 drop OD
Olopatadine (Patanol)	0.1%	1-2 drops BD
Cetirizine (Zerviate)	0.24%	1 drop BD
Azelastine (Optivar)	0.05%	1 drop BD
Epinastine (Elestat)	0.05%	1 drop BD
Bepotastine (Bepreve)	1.5%	1 drop BD
Ketotifen (Zaditor/Zyrtec Eye)	0.025%	1 drop BD

Olopatadine 0.1% BD or 0.2% OD is the most commonly used first-line agent.

For a quick Rx to write:

Olopatadine 0.1% eye drops
- 1-2 drops in each affected eye twice daily
- Duration: 4-6 weeks (or as needed during allergy season)

Moderate with significant itching - add:

Drug	Dose
Ketorolac 0.5% (topical NSAID)	1 drop QID - reduces inflammation (monitor for corneal toxicity if chronic use)

Severe (short course, under ophthalmology guidance)

Drug	Dose
Loteprednol 0.2% (mild steroid)	1 drop QID
Fluorometholone 0.1%	1 drop QID

Note: Routine topical antibiotics and steroids are NOT recommended for routine allergic conjunctivitis. Steroids require IOP monitoring.

Systemic support (moderate-severe)

Drug	Dose
Loratadine 10 mg	Once daily orally
Cetirizine 10 mg	Once daily orally
Diphenhydramine 25 mg	Three times daily orally

Non-pharmacological measures

Cool compresses several times a day - significantly reduces itching
Eliminate or avoid the allergen (dust, pollen, pet dander)
Frequent washing of hair and clothes
Do not rub the eyes (worsens mast cell degranulation)

When to refer to Ophthalmology

No improvement after 2 weeks
Severe cases with shield ulcer or corneal involvement (vernal/atopic conjunctivitis)
If steroid drops are needed (require IOP monitoring)
Vision affected at any point

Sources: The Wills Eye Manual 6e; Tintinalli's Emergency Medicine; The Harriet Lane Handbook 23e

Disclaimer: This is for clinical reference only. Prescribe based on individual patient assessment, local drug availability, patient age, and any contraindications.

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