A comparative study of azelastine, cromolyn and olopatadine ophthalmic solution in vernal keratoconjunctivitis in a tertiary care hospital-open label parallel group study design

Gaurav Sharma, Kulbhushan P. Chaudhary, Sushma Sawaraj


Background: Vernal keratoconjunctivitis (VKC) is a chronic, bilateral, external ocular inflammatory disease primarily affecting young boys living in warm, dry climates with seasonal variations. The disease causes lot of discomfort to the patient and sometimes can predispose to serious problems like shield ulceration and keratoconus. A number of drugs are used in the management of the condition, with variable results. The aims and objectives of this study was to compare the efficacy and safety of the drugs, cromolyn sodium, azelastine and olopatadine ophthalmic solutions in the treatment of VKC.

Methods: Sixty patients of VKC were studied over a period of 6 weeks. They were divided into 3 groups randomly to receive one of the drugs under study. Symptoms and signs were recorded after detailed questioning and examination according to modified criterion of Tabbara and Arafat.

Results: There was significant reduction in the mean itching scores with olopatadine as compared to cromolyn sodium and azelastine (p<0.05). Olopatadine significantly decreased mean lacrimation scores as compared to cromolyn sodium and azelastine (p<0.005). Olopatadine, cromolyn and azelastine showed significant reduction of corneal stippling, but no drug was significantly better than the other. Both cromolyn and olopatadine showed reduction of limbal edema equally (p<0.05), olopatadine reduced limbal edema more significantly as compared to azelastine (p<0.05).

Conclusions: All the three drugs were found to be safe in the treatment of VKC. Olopatadine may be preferred over the other two drugs since it reduced both itching and discharge most significantly.


VKC, Olopatadine, Azelastine, Cromolyn sodium, Allergic conjunctivitis

Full Text:



Neumann E, Gutmann MJ, Blumankrantz N, Michaelson IC. A review of four hundred cases of vernal conjunctivitis. Am J Ophthalmol. 1959;47(2):166-72.

Leonardi A, Sathe S, Bortolotti M, Beaton A, Sack R. Cytokines, matrix metalloproteases, angiogenic and growth factors in tears of normal subjects and vernal keratoconjunctivitis patients. Allergy. 2009;64(5):710-7.

Leonardi A, Bogacka E, Fauquert JL, Kowalski ML, Groblewska A, Jedrzejczak-Czechowicz M, et al. Ocular allergy: recognizing and diagnosing hypersensitivity disorders of the ocular surface. Allergy. 2012;67(11):1327-37.

Leonardi A. Vernal keratoconjunctivitis: pathogenesis and treatment. Prog Retin Eye Res. 2002;21(3):319-39.

Tabbara KF. Ocular complications of vernal keratoconjunctivitis. Can J Ophthalmol. 1999;34(2):88-92.

Bonini S, Lambiase A, Marchi S, Pasqualetti P, Zuccaro O, Rama P, et al. Vernal keratoconjunctivitis revisited: a case series of 195 patients with long-term follow up. Ophthalmology. 2000;107(6):1157-63.

Tabbara FK, Arafat TN. Cromolyn effects on vernal keratoconjunctivitis in children. Arch Ophthalmol. 1977;95(12):2184-6.

Leonardi A. Management of vernal keratoconjunctivitis. Ophthalmol Ther. 2013;2(2):73-88.

Kawuma M. The clinical picture of vernal kerato-conjunctivitis in Uganda. Commun Eye Health. 2001;14(40):66-7.

Chaudhary KP. Evaluation of combined systemic aspirn and cromolyn sodium in intractable vernal catarrh. Ann Ophthalmol. 1990;22(8):314-8.

Katelaris CH, Ciprandi G, Missoten L, Turner FD, Bertin D, Berdeaux G, et al. A comparison of efficacy and tolerability of olopatadine hydrochloride 0.1% ophthalmic solution and cromolyn sodium 0.2% ophthalmic solution in seasonal allergic conjunctivitis. Clin Ther. 2002;24(10):1561-75.

Spangler DL, Bensch G, Berdy GJ. Evaluation of clinical efficacy of olopatadine 0.1% ophthalmic solution and azelastine hydrochloride 0.05% ophthalmic solution in the conjunctival allergen challenge model. Clin Ther. 2001;23(8):1272-80.

Corum I, Yeniad B, Bilgin LK, Ilhan R. Efficiency of olopatadine hydrochloride 0.1% in the treatment of vernal keratoconjunctivitis and goblet cell density. J Ocul Pharmacol Ther. 2005;21(5):400-5.

Lichtenstein SJ, Pasquine TA, Edwards MR, Wells DT, Gross RD, Robertson SM. Safety and tolerability of olopatadine 0.2% in children and adolescents. J Ocul Pharmacol Ther. 2007;23(4):366-71.