Inadvertent conjunctival trauma related to contact with drug container tips: a masquerade syndrome.
OBJECTIVE
To report the diagnosis, clinical course, and management of acute painful red eye syndrome associated with unintentional tube- or bottle-tip-induced conjunctival trauma.


METHODS
A small, noncomparative, interventional case series.


METHODS
Twelve eyes of 12 patients (8 female and 4 male, aged 21-84 years) who were urgently reported or referred with a variety of diagnoses resulting from acute onset of red, painful eye. Four eyes had corneal transplants, two were recovering from herpetic keratitis, two had undergone cataract surgery or a laser in situ keratomileusis procedure, one had a corneal neurotrophic ulcer, and one used a contact lens. All the patients had received new medications (ophthalmic ointments in nine patients, topical drops in three patients) within 1 week before onset of symptoms.


METHODS
Assessment of method of self-administration of topical medication, evaluation of the ocular surface lesion, and patient education.


METHODS
Association of patient behavior with ocular surface lesions.


RESULTS
All 12 patients presented red, painful eyes, congested lower palpebral conjunctiva, epithelial conjunctival erosions, and episcleritis. In all patients, direct contact of the tube or bottle-tip with the affected area of the conjunctiva was ascertained by inspection. Instructions on proper method of drug administration and eye patching with lubrication were followed, within 2 weeks, by healing of conjunctival lesions.


CONCLUSIONS
Drug containers may cause nonintentional conjunctival trauma and simulate severe ocular disorders. Physicians should be aware of this diagnosis in any case of prolonged and unexplained ocular irritation and should instruct patients as to the proper instillation of topical ophthalmic medications.
Solomon
Abraham
A
Department of Ophthalmology, Hadassah University Hospital, Jerusalem, Israel. avisol@md.huji.ac.il
Chowers
Itai
I
Raiskup
Frederik
F
Siganos
Charalambos S
CS
Frucht-Pery
Joseph
J
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003228:Conjunctiva / Q000293:injuries*; D003231:Conjunctivitis / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D003937:Diagnosis, Differential; D004349:Drug Packaging; D005131:Eye Injuries / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009824:Ointments; D009883:Ophthalmic Solutions; D010353:Patient Education as Topic; D015423:Scleritis / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D012646:Self Administration; D013577:Syndrome
D009824:Ointments; D009883:Ophthalmic Solutions