ACUTE AND CHRONIC CONJUNCTIVITIS DUE TO OVER-THE-COUNTER OPHTHALMIC DECONGESTANTS

Objective: To describe patterns of conjunctivitis caused by ophthalmic decongestants. Design: Case series. Setting: Outpatient eye clinic. P atients: We selected patients with conjunctival inflammation who were using nonprescription decongestant eyedrops, who had no other cause fo r conjunctivitis, and whose conditions improved after discontinuing th e incriminated preparations. Main Outcome Measures: Clinical character istics of conjunctival inflammation and time to resolution of symptoms and signs after discontinuing the use of eyedrops. Results: Seventy p atients (137 eyes) were identified. Preparations containing the vasoco nstrictors naphazoline, tetrahydrozoline, or phenylephrine were associ ated with 3 clinical patterns of conjunctivitis: conjunctival hyperemi a (50 cases), follicular conjunctivitis (17 cases), and eczematoid ble pharoconjunctivitis (3 cases). Decongestants were used daily for a med ian 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 decongest ant eyedrops can produce acute and chronic forms of conjunctivitis by pharmacological, toxic, and allergic mechanisms. Once recognized, conj unctival inflammation often takes several weeks to resolve.