Epimax-related ocular surface toxicity on a background of topical steroid withdrawal syndrome

A man in his 20s with a background of severe atopic eczema presented with a 24-hour history of intense pain, redness and blurred vision in his left eye. The day before symptom onset, the patient recalls applying Epimax to above the left eyelid. Examination of the left eye revealed findings consistent with a presentation suggestive of chemical injury, demonstrating a total corneal epithelial defect with associated stromal haze. The patient initially declined topical corticosteroid therapy due to prior complications with steroid-induced dermatitis that had necessitated prolonged hospitalisation. After treatment with intensive lubricant, antibiotic and dexamethasone drops, the patient made a good clinical recovery over 1 week. A modified, time-limited course of steroid drops was prescribed and the patient experienced no recurrence of steroid dermatitis. Healthcare professionals should counsel patients on the risks of periocular application of Epimax and maintain awareness of its potential to cause ocular surface toxicity.