Drug-Induced Periocular and Ocular Surface Disorders: An EAACI Position Paper

Area of Science:

• Ophthalmology
• Dermatology
• Pharmacology

Background:

• Systemic and topical medications can cause ocular and periocular adverse effects (AEs).
• These AEs range from mild to severe, potentially leading to ocular surface (OS) damage or serious complications.
• Drug-induced ocular reactions are classified as toxic or allergic (IgE or non-IgE-mediated).

Purpose of the Study:

• To provide a comprehensive overview of drug-induced ocular AEs.
• To detail clinical presentations, diagnostic approaches, and treatment strategies.
• To integrate the latest literature and clinical guidelines on managing these conditions.

Main Methods:

• Literature review and synthesis of current clinical guidelines.
• Analysis of evidence implicating various drug classes in ocular AEs.
• Focus on recent findings related to biological treatments.

Main Results:

• Commonly implicated drugs include systemic antibiotics, antivirals, anticonvulsants, antihistamines, beta-blockers, antipsychotics, antidepressants, and isotretinoin.
• Topical treatments like antibiotics, antiglaucoma medications, preservatives, and cosmetics can also cause ocular AEs.
• Biologicals (e.g., EGFR inhibitors, dupilumab) are increasingly associated with ocular surface diseases like conjunctivitis, meibomitis, and dry eye.

Conclusions:

• Drug-induced ocular AEs are a significant clinical concern requiring careful diagnosis and management.
• Understanding the diverse mechanisms and clinical manifestations is crucial for effective treatment.
• This review offers a framework for clinicians managing patients with medication-related ocular surface issues.