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Ocular surface damage by ophthalmic compounds

Mantelli, Flavio; Tranchina, Laura; Lambiase, Alessandro; Bonini, Stefano

Current Opinion in Allergy and Clinical Immunology: October 2011 - Volume 11 - Issue 5 - p 464–470
doi: 10.1097/ACI.0b013e32834a95c9
Eye allergy: Edited by Leonard Bielory and Stefano Bonini

Purpose of review To describe the changes of the ocular surface following chronic use of eye drop therapies. The possible pathogenetic mechanisms responsible for specific signs and symptoms are described and discussed.

Recent findings Topical treatments for ocular diseases may trigger an inflammatory response in predisposed patients, with local activation of immune cells and ocular surface damage. The resulting clinical picture may vary substantially, from mild to severe, sharing a red eye as a hallmark presentation. Recent in-vitro, in-vivo, and clinical data suggest that these detrimental effects are not solely related to eye drop preservatives and may be caused by the medication itself, especially for patients with preexisting ocular diseases. However, no specific tests are currently available to make a clear cut diagnosis between what is caused by the disease and what is the effect of its therapy. Patients’ history and clinical features remain essential to hypothesize the underlying pathogenetic mechanism.

Summary Topical therapies may induce ocular surface allergic reactions, dry eye-like reactions, and epithelial damage. Patients in need of chronic therapies are at higher risk of facing these detrimental effects of eye drop therapies and should be treated with unpreserved compounds.

aDepartment of Ophthalmology, Campus Bio-Medico, University of Rome

bDepartment of Biopathology, Ophthalmology Division, UOSD Glaucoma, University of Rome ‘Tor Vergata’, Rome, Italy

Correspondence to Professor Stefano Bonini, MD, Department of Ophthalmology, Campus Bio-Medico, University of Rome, Via Alvaro del Portillo 28, 00121 Rome, Italy Tel: +39 06 225419185; fax: +39 06 22541456; e-mail:

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