title: Inadvertent conjunctival trauma related to contact with drug container tips: a masquerade syndrome.
abstract: 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.
authors.affiliation: Department of Ophthalmology, Hadassah University Hospital, Jerusalem, Israel. avisol@md.huji.ac.il
authors.forename: Abraham
authors.initials: A
authors.lastname: Solomon
authors.forename: Itai
authors.initials: I
authors.lastname: Chowers
authors.forename: Frederik
authors.initials: F
authors.lastname: Raiskup
authors.forename: Charalambos S
authors.initials: CS
authors.lastname: Siganos
authors.forename: Joseph
authors.initials: J
authors.lastname: Frucht-Pery
mesh_terms: 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
chemical_list: D009824:Ointments; D009883:Ophthalmic Solutions