Avoiding Glaucoma Surgery Through Allergen Identification by Skin Testing: A Case Report

Drug-induced allergic reactions are unpredictable because almost all pharmaceuticals can act as allergens. Accurate identification and avoidance of suspected drugs are critical to prevent serious adverse events. Glaucoma is a chronic condition that causes irreversible vision loss and requires ongoing intraocular pressure (IOP) monitoring and management. This report describes the case of an 83-year-old man with elevated IOP in the left eye due to exfoliative glaucoma. The patient had a history of cataract surgery and allergic reactions to polyvinyl alcohol-iodine eye drops, lidocaine, and oxibuprocaine hydrochloride (Benoxil). IOP was monitored using non-contact tonometry. A dermatologist's skin prick test (also referred to as a scratch test in Japan) showed that lidocaine was the only drug that caused an allergic reaction before the surgical intervention. This allowed for the safe reintroduction of benoxil and the accurate measurement of IOP using Goldmann tonometry. Accurate IOP readings with Goldmann applanation tonometry optimized medical therapy to avoid surgery. Allergy testing can enhance glaucoma management through reliable IOP assessments. This highlights the importance of proactively identifying allergenic drugs for lifelong glaucoma care.