Toxic Keratoconjunctivitis (Medicamentosa)

Toxic Keratoconjunctivitis (Medicamentosa)
SYMPTOMS Pain | Photophobia | Blurry vision | Tearing
SIGNS Corneal SPK | Conjunctival papillae and/or follicles | Conjunctival injection
WORK-UP Thorough history. Slit lamp examination with NaFl dye
TREATMENT Discontinue offending agent | Preservative-free artificial tears q1h | Topical steroids may be indicated if significant inflammation and/or discomfort - Pred Forte 1% 1 gtt qid in affected eye | Eye lavage may be beneficial, but should only be done if the offending agent is one that does not react violently with water | Oral analgesics may be used to control pain (acetaminophen, ibuprofen, etc.) | Bandage contact lenses or amniotic membranes may be used if appropriate |
FOLLOW-UP Every few days during treatment
ETIOLOGY A number of noxious agents can cause toxic keratoconjunctivitis (i.e. glaucoma drops, topical NSAIDs, BAK preservative, etc.)
DIFFERENTIAL DX Allergic conjunctivitis | EKC | Dry eye syndrome | Episcleritis