The dermatological adverse effects associated with anti-glaucoma eye drops were outlined in data from a literature review published in the Journal of the European Academy of Dermatology and Venereology. In addition to ocular side effects, distant adverse effects may be observed throughout the body.

Investigators conducted a systematic search of PubMed from inception through January 2020 for studies describing the dermatological manifestations of anti-glaucoma treatment. Studies written in English, French, German, or Spanish were eligible for inclusion. The initial search retrieved 1128 studies, from which a total of 123 were selected for full-text review. Case data were extracted and assembled into 2 categories: ocular/periocular adverse effects and distant dermatological effects.   

Ocular and periocular effects included 65 cases of allergic contact dermatitis; 58 of hyperpigmentation; 46 of prostaglandin analogue periorbitopathy; 44 of mucous membrane pemphigoid; 10 of eyelash depigmentation; 9 of skin hypertrichosis; 5 of melanoma; 3 of skin depigmentation; and 1 of contact urticaria. Ocular and periocular manifestations typically resolved or improved with discontinuation of treatment. Benzalkonium chloride was the suspected causative agent in a significant percentage of cases with contact dermatitis or mucous membrane pemphigoid. Other suspected agents included timolol, pilocarpine, dipivefrine, epinephrine, echothiophate iodide, betaxolol, apraclonidine, carbachol, demecarium bromide, and latanoprost. Prostaglandin-associated periorbitopathy was most common in older patients, bimatoprost users, and travoprost users.


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Distant dermatological adverse events included 11 cases of psoriasis; 5 of excessive sweating; 4 of lichen planus; 2 of alopecia, 2 of toxic epidermal necrolysis; 2 of erythema multiforme; and 1 each of erythroderma, subacute cutaneous lupus erythematosus, nail pigmentation, and bullous pemphigoid. These events resolved or improved with treatment discontinuation. Melanoma possibly induced by eye drops was reported by 5 patients 2 months to 10 years after treatment onset. The causative agent in these cases was unclear.

Results from this literature review provide a broad summary of eye drop-induced dermatological effects, the investigators wrote. They also suggested that clinicians should be aware of the potential risks and screen patients with these disorders for use of glaucoma treatment. Further study is necessary to better explore certain rare severe manifestations, such as melanoma and toxic epidermal necrolysis, it was noted.

“Although scarce, these data invite us to consider non-systemic drugs in severe cutaneous adverse reactions,” investigators wrote. “Distant adverse effects are rare and sometimes questionable but should be kept in mind, especially mucous membrane pemphigoid, which could lead to blindness. The role of preservatives, such as benzalkonium chloride, should also be considered.”

Reference

Patchinsky A, Petitpain N, Gillet P, Angioi-Duprez K, Schmutz JL, Bursztejn AC. Dermatological adverse effects of anti-glaucoma eye drops: a review. J Eur Acad Dermatol Venereol. Published online January 15, 2022. doi:10.1111/jdv.17928