title: Ocular surface damage by ophthalmic compounds.
abstract: OBJECTIVE
  To describe the changes of the ocular surface following chronic use of eye drop therapies. The possible pathogenetic mechanisms responsible for specific signs and symptoms are described and discussed.
  
  
  RESULTS
  Topical treatments for ocular diseases may trigger an inflammatory response in predisposed patients, with local activation of immune cells and ocular surface damage. The resulting clinical picture may vary substantially, from mild to severe, sharing a red eye as a hallmark presentation. Recent in-vitro, in-vivo, and clinical data suggest that these detrimental effects are not solely related to eye drop preservatives and may be caused by the medication itself, especially for patients with preexisting ocular diseases. However, no specific tests are currently available to make a clear cut diagnosis between what is caused by the disease and what is the effect of its therapy. Patients' history and clinical features remain essential to hypothesize the underlying pathogenetic mechanism.
  
  
  CONCLUSIONS
  Topical therapies may induce ocular surface allergic reactions, dry eye-like reactions, and epithelial damage. Patients in need of chronic therapies are at higher risk of facing these detrimental effects of eye drop therapies and should be treated with unpreserved compounds.
authors.affiliation: Department of Ophthalmology, Campus Bio-Medico, University of Rome, Rome, Italy.
authors.forename: Flavio
authors.initials: F
authors.lastname: Mantelli
authors.forename: Laura
authors.initials: L
authors.lastname: Tranchina
authors.forename: Alessandro
authors.initials: A
authors.lastname: Lambiase
authors.forename: Stefano
authors.initials: S
authors.lastname: Bonini
mesh_terms: D060433:Administration, Ophthalmic; D018926:Anti-Allergic Agents / Q000009:adverse effects / Q000627:therapeutic use; D015415:Biomarkers / Q000378:metabolism; D004198:Disease Susceptibility; D004342:Drug Hypersensitivity / Q000209:etiology / Q000276:immunology / Q000473:pathology / Q000503:physiopathology; D015352:Dry Eye Syndromes; D004848:Epithelium / Q000187:drug effects / Q000276:immunology / Q000378:metabolism* / Q000473:pathology; D005123:Eye / Q000473:pathology*; D005128:Eye Diseases / Q000150:complications / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D007249:Inflammation; D055271:Mucin 5AC / Q000378:metabolism; D009883:Ophthalmic Solutions / Q000009:adverse effects / Q000627:therapeutic use; D011310:Preservatives, Pharmaceutical / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D018926:Anti-Allergic Agents; D015415:Biomarkers; C524678:MUC5AC protein, human; D055271:Mucin 5AC; D009883:Ophthalmic Solutions; D011310:Preservatives, Pharmaceutical