Toxic keratoconjunctivitis is an inflammation of the bulbar and palpebral conjunctiva with corneal involvement due to exposure to foreign substance(s).
• Use of topical ophthalmic medications, eye cosmetics, and contact lenses. Further, periocular molluscum contagiosum
• Exposure to environmental irritants
Avoidance of known irritants
Nonantigenic induction of lymphocytes resulting in mitotic and lymphoblastic transformation
• Exposure to environmental irritants, topical ophthalmic medications, contact lenses and solutions, and eye cosmetics
• Prolonged use of ophthalmic medications including glaucoma medications (e.g., brimonidine, apraclonidine, pilocarpine), antivirals (e.g., trifluridine), antibiotics (e.g., neomycin, gentamicin), and cycloplegics (e.g., atropine, homatropine)
• Preservatives in ophthalmic medications and solutions(i.e., benzalkonium chloride)
• Preservative-containing soaking solutions and enzymatic cleansers in contact lens wearers
• Proteins that spill from molluscum contagiosum lesions
Ocular redness, burning, irritation, and tearing with gradual onset from initial exposure to irritant or use of ophthalmic agent
• Diffuse conjunctival injection associated with a follicular response
• Follicles are enlarged and inflamed and mostly noted in the inferior fornix and palpebral conjunctiva
• Punctate epithelial staining of the cornea
• Mild periocular erythema or edema
• Periocular molluscum contagiosum lesions: Elevated, round, white lesions with an umbilicated center
DIAGNOSTIC TESTS & INTERPRETATION
True lymphoid follicles that contain germinal centers with lymphoblasts
Allergic, bacterial, or viral conjunctivitis, dry eye, blepharitis, and contact lens overwear
• Avoid exposure to, or discontinue use of, the offending agent, if possible
• Preservative-free artificial tears 4–8 times daily
• Artificial tear ointment at bedtime as needed
• Mild topical steroid may be considered in severe cases that are not responsive to first-line therapy
– Treatment with topical steroid should be initiated by an eye care provider.
• Identification and removal of offending agent
• Contact lens holiday. Use of another contact lens-care solution when contact lens use is resumed
Issues for Referral
• Failure to respond to treatment
• Referral to an eye care provider when there is visual impairment
Curettage or excision of molluscum contagiosum lesions
• Approximately 1 week following the initiation of treatment, although follow-up should be based on severity of disease and comorbidities
– When glaucoma medications are stopped, closely monitor intraocular pressure
Monitor vision. With topical steroid use, monitor intraocular pressure and intraocular lens
• Risks of topical steroid use include glaucoma, cataract formation, and predisposition to infection. Treatment with topical steroid should be a short-term treatment only.
• Patients should be advised to follow up sooner than advised if there is a progression in symptoms or if symptoms are accompanied by visual impairment.
Elevation of intraocular pressure when glaucoma medications are stopped
• Dart J. Corneal toxicity: The epithelium and stroma in iatrogenic and factitious disease. Eye (Lond.) 2003;17:886–892.
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• Wilson FM II. Adverse external ocular effects of topical ophthalmic therapy: An epidemiologic, laboratory, and clinical study. Trans Am Ophthalmol Soc 1983;81:854–965.
• Wilson FM II. Adverse external ocular effects of topical ophthalmic medications. Surv Ophthalmol 1979;24:57.
370.49 Other keratoconjunctivitis, unspecified