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January 1997

Acute and Chronic Conjunctivitis Due to Over-the-counter Ophthalmic Decongestants

Author Affiliations

From the Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Tex. The authors have no commercial or proprietary interest in the products discussed in this article.

Arch Ophthalmol. 1997;115(1):34-38. doi:10.1001/archopht.1997.01100150036004

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.

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