Netarsudil-associated conjunctival pigmentation

To present a case of conjunctival pigmentation associated with topical use of netarsudil 0.02 % (Rhopressa, Alcon, Fort Worth, TX).

Bilateral conjunctival pigmentation and cornea verticillata developed after 21 months of initiating netarsudil treatment. The appearance of the conjunctival pigmentation mimicked primary acquired melanosis. Both the conjunctival and corneal findings resolved 14 months after stopping the medication.

While the correlation between netarsudil use and corneal verticillata is well-established, we could not identify prior reports of such an association with conjunctival pigmentation. Eye care professionals prescribing netarsudil should be aware of this potential sequela of therapy.