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Polyquaternium-1–Associated Dendritiform Keratopathy

Verkade, Angela, MD; Matoba, Alice Y., MD

doi: 10.1097/ICO.0000000000001885
Case Report

Purpose: To report a case of polyquaternium-1 (Polyquad, PQ-1)–associated dendritiform keratopathy that developed after exposure to the tear substitute Systane (Alcon Laboratories, Inc, Fort Worth, TX).

Methods: A retrospective review of the case was performed.

Results: Dendritiform keratopathy developed in the patient after an increase in the use of topical Systane from 4 times per day to every hour. Keratopathy resolved with discontinuation of Systane.

Conclusions: Polyquaternium-1–associated dendritiform keratopathy can occur in patients who have previously tolerated the preservative. Because keratopathy seems to have developed and improved because of dose-dependent factors, the mechanism is more likely toxicity than hypersensitivity.

Department of Ophthalmology, Baylor College of Medicine, Houston, TX.

Correspondence: Alice Y. Matoba, MD, Alkek Eye Center, 1977 Butler Boulevard, E3.210, Houston, TX 77030 (e-mail:

The authors have no funding or conflicts of interest to disclose.

A. Verkade: writing of the manuscript and clinical management of the patient. A. Y. Matoba: writing of the manuscript, analysis of clinical information, and clinical management of the patient.

Received September 19, 2018

Accepted November 19, 2018

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