Ocular complications of a topical methylene blue-vasoconstrictor-anesthetic preparation

We describe six patients who demonstrated a spectrum of adverse ocular reactions following the use of a nonprescription topical medication composed of methylene blue, naphazoline hydrochloride or nitrate, and amylocaine hydrochloride. This preparation has been commonly sold in Quebec and France for various complaints of ocular discomfort and redness. The ocular complications included asymptomatic blue discoloration of the conjunctiva, follicular and papillary conjunctivitis and varying degrees of cicatrization of the conjunctiva and cornea. The most severe reaction, progressive bilateral ocular pseudopemphigoid, occurred in a 73-year-old woman, presumably due to at least one of the ingredients of this medication.