Inadvertent conjunctival trauma related to contact with drug container tips - A masquerade syndrome

Purpose: To report the diagnosis, clinical course, and management of acute painful red eye syndrome associated with unintentional tube- or bottle-tip-induced conjunctival trauma. Design: A small, noncomparative, interventional case series. Participants: 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. Intervention: Assessment of method of self-administration of topical medication, evaluation of the ocular surface lesion, and patient education. Main Outcome Measures: 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. (C) 2003 by the American Academy of Ophthalmology.