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Abstract #47061 Published in IGR 13-3
Allergic blepharoconjunctivitis caused by antiglaucomatics-Central Slovakia experiences
Urbancek S; Kuklova M; Hazuchova HK; MartinaskovaDermatitis 2011; 22: 185-186
Introduction: Glaucoma is a chronic, progressive, optic neuropathy that might be asymptomatic at the time of initial diagnosis; however, it can lead to visual field loss and blindness. Allergic reaction to antiglaucoma eye drops is rare. To date, approximately ten medications used for glaucoma therapy have been identified as allergens. Patients and Methods: Retrospective analysis of three patients treated with antiglaucoma eye drops at the Department of Ophthalmology, F. D. Roosevelt Hospital in Banska Bystrica. Initial presentation in all patients was that of blepharoconjunctivitis. The TROLAB patch tests with European standard battery, ophthalmologics, vehicles/ emulsifiers, antimicrobials, and individual topical antiglaucoma eye drops in serial dilutions (1-10-50% aq - as is) have been performed. Individual allergens had been tested also on healthy volunteers. Results: Allergy to active substances was confirmed by patch tests to individual topical drugs. The first patient was sensitized to carbo-anhydrase inhibitor, 10% dorzolamid (Trusopt); the second to 10% timolol in le Cosopt eyedrops; and the third one to prostaglandin derivative, 50% travoprost (Travatan). Control tests were negative. The time to sensitization was 12 to 24 months. Allergy to vehicles and conservants has been excluded by specific sets of patch tests listed above. The first patient was previously misdiagnosed as bacterial conjunctivitis, later as an ocular rosacea. Diagnosis in all patients was also confirmed by positive elimination tests; blepharoconjunctivitis disappeared rapidly after change of treatment to a chemically different molecule. Discussion: Antiglaucomatics are a heterogeneous group of drugs consisting of five active compounds: beta-blockers, cholinergics, alpha-2 adrenergic drugs, prostaglandin derivates, and carbo-anhydrase inhibitors. All these are believed to have a weak allergenic potential, with only small series and few case reports published to date. The most frequent reason for contact sensitization is beta-blockers. Cutaneous reactions are usually mild and transitory, but systemic reactions of a serious nature can occur. The proper diagnosis requires exclusion of allergy to additives in eye drops. The authors present three cases of sensitization to three chemically different active substances. Despite the clear clinical picture, the diagnosis is sometimes difficult. Possible reasons are low symptom specificity, long time interval (several months) for the sensitization to develop, and weak reactions to patch tests. The diagnosis may be also complicated by limited availability of pure active substances for patch testing from manufacturers. Allergenic potential of each subgroup, cross reactivity, and possibility of hyposensitization to antiglaucoma drugs will be discussed in this communication. Conclusion: The authors present three cases of allergic reaction to three chemically different antiglaucomatics (carbo-anhydrase inhibitor, beta-blocker, and prostaglandin derivate) which developed several months/years after initial use. Clinical picture, personal history, patch tests, elimination test, and cooperation with ophthalmologist are the key prerequisites for correct diagnosis.
S. Urbancek. Department of Dermatovenereology, F. D. Roosevelt Hospital, Banska Bystrica, Slovakia.
Classification:
2.1 Conjunctiva (Part of: 2 Anatomical structures in glaucoma)