Acute and chronic conjunctivitis due to over-the-counter ophthalmic decongestants
C. N. Soparkar, K. R. Wilhelmus, D. D. Koch, G. W. Wallace and D. B. Jones
Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Tex., USA.
OBJECTIVE: To describe patterns of conjunctivitis caused by ophthalmic
decongestants. DESIGN: Case series. SETTING: Outpatient eye clinic.
PATIENTS: We selected patients with conjunctival inflammation who were
using nonprescription decongestant eyedrops, who had no other cause for
conjunctivitis, and whose conditions improved after discontinuing the
incriminated preparations. MAIN OUTCOME MEASURES: Clinical characteristics
of conjunctival inflammation and time to resolution of symptoms and signs
after discontinuing the use of eyedrops. RESULTS: Seventy patients (137
eyes) were identified. Preparations containing the vasoconstrictors
naphazoline, tetrahydrozoline, or phenylephrine were associated with 3
clinical patterns of conjunctivitis: conjunctival hyperemia (50 cases),
follicular conjunctivitis (17 cases), and eczematoid blepharoconjunctivitis
(3 cases). Decongestants were used daily for a median of 3 years (range, 8
hours to 20 years) prior to presentation. The median time to resolution of
symptoms and signs was 4 weeks (range, 1-24 weeks), and patients remained
asymptomatic for a median follow-up of 6 months (range, 0-12 years).
CONCLUSION: Nonprescription decongestant eyedrops can produce acute and
chronic forms of conjunctivitis by pharmacological, toxic, and allergic
mechanisms. Once recognized, conjunctival inflammation often takes several
weeks to resolve.
