A 58-year-old man developed allergic contact conjunctivitis after receiving phenylephrine/tropicamide eye drops in preparation for cataract surgery.
The man, who had previously used the drug without adverse reaction, was instilled with 10% phenylephrine/0.5% tropicamide eye drops [dosage not stated] for cataract surgery in June 2013. Four hours later, he reported severe burning in his eyes, swelling and erythema of both eyelids. Conjunctival congestion was present bilaterally.
Surgery was delayed and the man was treated with corticosteroid eye drops. His symptoms had resolved within 5 days.
The man was admitted to hospital in October 2013 for the rescheduled surgery. He was again instilled with phenylephrine/tropicamide eye drops and, 3 hours later, he developed the same symptoms.
Five weeks after resolution of the second episode, patch testing using 10% aqueous dilution of phenylephrine/tropicamide instillation was carried out. At 48 hours, the patch test for phenylephrine was positive. The patch test for tropicamide was negative.
Author comment: "The responsibility of Phenylephrine induced conjunctivitis was retained, referring to Begaud's method of imputation, with a score of 13 (likely) because of the suggestive delay of onset (4h after starting instillations), the positive rechallenge in shorter delay and the positive patch test to phenylephrine."
Reference
Charfi O, et al. Allergic contact conjonctivitis to phenylephrine hydrochloride eyedrops with positive patch testing. Fundamental and Clinical Pharmacology 28 (Suppl. 1): 95 abstr. P-024, May 2014 [abstract] - Tunisia
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Phenylephrine/tropicamide. Reactions Weekly 1540, 245 (2015). https://doi.org/10.1007/s40278-015-8093-7
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DOI: https://doi.org/10.1007/s40278-015-8093-7