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Jonathan C. Roos, Cornelius RENÉ; Identification of Agents Responsible for Drug-Induced Contact Dermatitis and Ocular Adnexal Sequelae. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1463.
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To highlight the adverse reactions of topical ocular medications on the ocular adnexae, ranging from ectropion to suspected recurrent orbital cellulitis.
A retrospective case series of patients presenting to the oculoplastic clinic with drug-induced ectropion with particular reference to the culprit medications. A review of published case reports and adverse drug events registries was performed to identify previously implicated agents.
5 patients developed drug-induced ectropion as a result of starting either azarga, atropine, azopt, apraclonidine or betagan treatment. None of these agents has been previously implicated in the causation of drug-induced ectropion. Due to polypharmacy a single agent could not be identified in 2 of the 5 cases. One patient was hospitalized twice and underwent extensive investigations, as well as receiving intravenous antibiotics for recurrent bouts of severe periorbital swelling which was wrongly presumed to be orbital/preseptal cellulitis, before being assessed by the oculoplastic team. Cessation of glaucoma medication and treatment with topical dexamethasone drops permitted resolution without a resultant pressure spike. A literature review did not identify any instances of pressure spikes following cessation of glaucoma medication for drug-induced ectropion.
In patients with chronic/recurrent orbital cellulitis and ectropion, drug-induced contact dermatitis should be considered early to avoid unecessary treatment, investigation and morbidity. We putatively link a number of newer glaucoma medications to the development of ectropion and provide a treatment algorithm to help clinicians approach this under-reported clinical entity. Finally, we discuss the potential pathophysiological link with common filaggrin mutations.
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