Immune-Mediated Diseases of the Eyelid

Figure 7-1 Acute anaphylactic reaction to topical ophthalmic medication with conjunctival hyperemia and chemosis.

A delayed type IV hypersensitivity reaction to a medication usually begins 24–72 hours following instillation of a topical agent. Patients are often sensitized by previous exposure to the offending drug or preservative. An acute eczematous reaction develops with erythema, leathery thickening, and scaling of the eyelid (Fig 7-2). Sequelae of chronic contact blepharoconjunctivitis include hyperpigmentation, dermal scarring, and lower-eyelid ectropion. A papillary conjunctivitis and a mucoid or mucopurulent discharge may develop. Punctate epithelial erosions may be noted on the inferior cornea. Medications that are commonly associated with contact blepharoconjunctivitis include

cycloplegics such as atropine and homatropine aminoglycosides such as neomycin, gentamicin, and tobramycin antiviral agents such as idoxuridine and trifluridine

preservatives such as thimerosal and ethylenediaminetetraacetic acid (EDTA)

Figure 7-2 Delayed allergic contact dermatitis secondary to topical ophthalmic medication.

MANAGEMENT Treatment of hypersensitivity reactions requires the identification and discontinuation of