Topical eye medications causing allergic contact dermatitis

Abstract

Background: Allergic contact dermatitis (ACD) in the eye region caused by topical eye medications is difficult to diagnose and may be overlooked.Objective: To study the characteristics and causative agents in patients with ACD caused by topical eye medications in a Danish tertiary dermatology department.Methods: A retrospective study of 318 patients, patch tested between 2013 and 2021 due to suspected ACD to topical eye medications. All patients were tested with a locally developed eye medication series, some were additionally tested with suspected eye medications. Medical records were studied in patch test positive patients.Results: Contact allergy to a topical eye allergen/medication was found in 12.9% (n = 41) of 318 patients, and culprit allergens were phenylephrine (6.9%), timolol (2.5%) and ketotifen (1.6%). Patch test positive patients were often previously diagnosed with cataract (29.3%) or glaucoma (24.4%), and the majority reported more than one previous reaction. Initial symptoms were oedema (56.0%), erythema (48.8%) and dermatitis (31.7%) in the eye region, and facial dermatitis was also seen. Conclusions:Patients with symptoms from the eye region who have been using topical eye medications should be patch tested with ingredients from commonly used eye medications supplemented by the products tested 'as is'.

Tobramycin and antiglaucoma agents as increasing culprits of periorbital allergic contact dermatitis from topical ophthalmic medications: A 24‐year study from Turkey

“…4,6 Ahlström et al further showed a negative association between the presence of atopic dermatitis and positive patch test reactions to TOMs. 7 In concordance with these findings, none of the patients with ACD from TOMs in our study exhibited atopic features.…”

“…present series (0.9%). Among those patch tested due to suspected TOM-induced periorbital ACD, the share of sensitization has been reported as 12.9%-67.7% in previous studies, 6,7,18 while this rate was 33.3% in our study.…”

“…1,16 A growing body of literature on periorbital ACD from TOMs has been published over the last decade. [3][4][5][6][7] A literature search on published case series and studies on this subject showed that the overall prevalence of sensitization to TOMs was 0.7% in Belgium 4 and 0.9% in Portugal, 6 and a similar rate was detected in the T A B L E 3 Positive patch test reactions and the clinical relevance with topical ophthalmic medications and their ingredients. present series (0.9%).…”

“…In previous studies, the patients over 40 years of age, who suffer more from ophthalmological problems, were found to comprise the majority of patients sensitized from the allergens in TOMs, which was consistent with our study findings. [4][5][6][7]18 Atopy has not been mentioned as a risk factor for sensitization to TOMs, despite their frequent use in patients with atopic dermatitis and allergic rhinoconjunctivitis. 4,6 Ahlström et al further showed a negative association between the presence of atopic dermatitis and positive patch test reactions to TOMs.…”

“…1,2 Only a few studies from Europe and a case series from Brazil have investigated the characteristics of ACD from TOMs. [3][4][5][6][7] Age older than 40 years, female predominance and topical aminoglycoside antibiotics/antiglaucoma agents as the main culprits were commonly reported features.…”