Contact dermatitis in patients undergoing serial intravitreal injections.
BACKGROUND
Anti-vascular endothelial growth factor (VEGF) medication, injected intravitreally, is currently the standard of care in patients with different retinal pathologies. Since its introduction in 2006, an increasing number of patients have undergone this procedure in Ghent University Hospital. Strikingly, more patients were diagnosed with contact dermatitis caused by ophthalmic products used during intravitreal injection procedure.


OBJECTIVE
To identify which of the substances used during intravitreal injection is most likely to cause contact dermatitis.


METHODS
Sixteen patients who developed a burning and stinging sensation and swelling of the eyelids after intravitreal injection were tested. All patients were patch tested with the Belgian baseline series, as well as a cosmetic, a pharmaceutical and an ophthalmic series, including the different eye drops used during the intravitreal injection procedure.


RESULTS
Fourteen of 16 patients reacted to at least one of the substances used during the injection procedure. Nine patients reacted to phenylephrine (56%), 5 to iso-Betadine(®) ophthalmic solution (31%), and 3 patients to sodium metabisulfite (16%).


CONCLUSIONS
The most common causal allergen was phenylephrine, being positive in 56% of patients. Patients most likely become sensitized because of the high frequency of usage of phenylephrine during repeated intravitreal injections and follow-up consultations.
Department of Dermatology, Ghent University Hospital, B-9000 Ghent, Belgium.
Jolien
J
Veramme
Department of Ophthalmology, Ghent University Hospital, B-9000 Ghent, Belgium.
Julie
J
de Zaeytijd
Department of Dermatology, Ghent University Hospital, B-9000 Ghent, Belgium.
Jo
J
Lambert
Department of Dermatology, Ghent University Hospital, B-9000 Ghent, Belgium.
Hilde
H
Lapeere
D000368:Aged; D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000009:adverse effects*; D017449:Dermatitis, Allergic Contact / Q000209:etiology*; D005260:Female; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions; D010328:Patch Tests; D010656:Phenylephrine / Q000008:administration & dosage / Q000009:adverse effects*; D011206:Povidone-Iodine / Q000008:administration & dosage / Q000009:adverse effects*; D013447:Sulfites / Q000008:administration & dosage / Q000009:adverse effects*; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*
D000891:Anti-Infective Agents, Local; D009883:Ophthalmic Solutions; D013447:Sulfites; D042461:Vascular Endothelial Growth Factor A; D010656:Phenylephrine; C005200:sodium metabisulfite; D011206:Povidone-Iodine
allergic contact dermatitis; intravitreal injection; ophthalmic procedure; phenylephrine; sodium metabisulfite