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Cromolyn sodium 4% effective choice for GPC
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Cromolyn sodium has been commonly used to treat giant papillary conjunctivitis (GPC), a condition seen less frequently in clinical practice since the advent of disposable soft contact lenses. Today, cromolyn sodium is still used for problems experienced by a few patients wearing disposable lenses, but more typically it is used for conventional soft lenses wearers. These are challenging patients because they frequently wear toric lenses with high cylinder or are wearing high powers of either myopic or hyperopic correction.
Converting to glasses is seldom an attractive option to these patients, so lens replacement and medical treatment offer our only hope of keeping them in lenses. A remaining option would be refractive surgery.
Crolom 4% (cromolyn sodium) is supplied by Bausch & Lomb in 2.5-mL and 10-mL bottles. It is preserved with 0.01% benzalkonium chloride and has a pH range of 4.0 to 7.0. This pH range can cause some stinging on instillation. The drops should be stored at temperatures from 59° to 86°F. Opened bottles should be discarded after 4 to 6 weeks. It is approved for children 4 years and older. Cromolyn sodium is poorly absorbed systemically, and only trace amounts are absorbed into the anterior chamber. The cromolyn that is absorbed is rapidly eliminated from the body.
Cromolyn sodium 4% administered as a nasal spray is used to treat allergic rhinitis and help control bronchial asthma, although it is not an effective treatment for acute asthma.
Stabilizes mast cells
Cromolyn sodium was synthesized in 1965 from an extract of a seed grown in the Eastern Mediterranean region. It primarily acts by stabilizing the mast cells, which are abundant in the conjunctiva. Stabilizing mast cells is helpful in IgE-mediated hypersensitivity reactions. These reactions are mediated by the release of histamine, leukotrienes, prostaglandins and eosinophil chemotactic factors from the mast cells. Stopping the release of these chemicals into the eyes blocks the inflammatory effects commonly seen with vernal, giant papillary, atopic and ragweed conjunctivitis.
Once the inflammatory chemicals have been released into the eyes, cromolyn sodium has no effect on reducing the inflammation caused by the chemicals. For that reason, other medications are needed in conjunction with cromolyn to reduce the initial reaction. The cromolyn helps prevent other mast cells from releasing additional inflammatory agents. It usually takes about 7 days before patients feel relief when using cromolyn sodium as their only treatment.
Improves eye comfort
| Points to consider when prescribing Crolom |
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Clinical studies in the 1980s found cromolyn to be an effective treatment for vernal and giant papillary conjunctivitis. A study by Felius in 1984 revealed an additional benefit: that cromolyn increased tear break-up time, which improved eye comfort.
Type IV hypersensitivity allergic reactions are not effectively treated with Crolom. This includes contact dermatitis, poison ivy and reactions to preservatives in contact lens solutions. These allergic reactions are better treated with steroids and antihistamine/ decongestants.
I have found cromolyn sodium to be most helpful for treating
Treatment options
For GPC grade 1 to 2, use Crolom four times daily for 1 to 2 weeks and then twice daily for 1 to 2 weeks, and use Naphcon A (naphazoline, Alcon) four times daily for 1 week and then twice daily for 1 week. Livostin (levocabastine HCl, Ciba Vision) four times daily for 1 week and then twice daily for 1 week is a second option. Supportive care would include removing contact lenses and considering other options, such as daily or 2-week disposables. Saline rinses and cold compresses also help relieve itch and reduce mucus.
For GPC grade 3 to 4, use Crolom four times daily for 2 weeks and then twice daily for 2 to 6 weeks; saline rinses four times daily for 2 weeks; cold compresses four times daily for 1 week and then twice daily for 1 week; Flarex (fluorometholone acetate 0.1%, Alcon) four times daily for the first week and then Livostin four times daily for the second week.
Discontinue contact lens wear for 1 to 2 months, and then consider rigid gas permeable lenses, 1-day disposables, glasses or refractive surgery.
To treat chronic allergic conjunctivitis from pollens, mold and dust, use Crolom four times daily for 2 weeks and then twice daily for 2 weeks to 2 months. Also, use Livostin four times daily for 1 week and then twice daily for 1 week, and use cold compresses twice daily for 1 week and then as needed. Saline rinses can also be used to help remove mucus in the early stages of treatment. Patanol (olopatadine, Alcon) may be prescribed twice daily as a preventive treatment during the allergy season, which is usually during the spring and fall in most regions
As a second-choice treatment plan for treating vernal conjunctivitis (Alomide would be first choice), use Crolom four times daily for 2 to 4 weeks and then twice daily for up to 3 months. Flarex may be required four times daily for 1 to 2 weeks and then twice daily for 2 to 4 weeks. Supportive therapy would include cold compresses four times daily and saline rinses four times daily for as long as needed.
Cromolyn sodium 4% is a safe eye drop used to help relieve the symptoms and inflammation of GPC and some forms of chronic conjunctivitis. It can be used safely for long-term treatment in combination with steroids and antihistamine/decongestants. Mast-cell stabilizers do not offer immediate relief, so patients need to be instructed to continue to use the drop to maintain long-term relief.
For Your Information:
- Crolomis available from Bausch & Lomb, One Bausch & Lomb Place, Rochester, NY 14604-2701.