latanoprost and Conjunctivitis--Allergic

This study evaluated the conjunctival effects of latanoprost and timolol, both of which contain benzalkonium chloride, in patients with primary open-angle glaucoma (POAG), with and without a history of allergic conjunctivitis (AC).. Two groups of 25 patients with and without a positive history for AC were studied. After a 21-day wash-out period patients were randomized to 14 days treatment with latanoprost or with timolol, in a cross-over fashion. The following parameters were evaluated on days 0 and 14: number of white blood cells, ferning test, conjunctival impression cytology, subjective symptoms, and objective ocular changes.. Latanoprost caused: (a) an increase in eosinophils in both groups and reduction in lymphocytes only in the group with a history of AC; (b) alterations in ferning test and impression cytology only in AC patients; and (c) development of subjective symptoms and objective signs only in non-AC glaucomatous subjects. Timolol therapy was responsible only for the occurrence of subjective symptoms and objective signs in non-AC patients.. Latanoprost treatment induces ocular surface changes which are more evident in POAG patients who are also affected by AC. These findings are probably related to the very high latanoprost concentration of benzalkonium chloride and to its bedtime administration, which further amplifies the toxicity.

Topics: Administration, Topical; Aged; Antihypertensive Agents; Benzalkonium Compounds; Conjunctiva; Conjunctivitis, Allergic; Cross-Over Studies; Eosinophils; Female; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Latanoprost; Leukocyte Count; Lymphocytes; Male; Middle Aged; Preservatives, Pharmaceutical; Prostaglandins F, Synthetic; Tears; Timolol

The case concerns an 81-year-old woman on treatment with a topical fixed combination of timolol and brimonidine who was diagnosed in the Emergency Department with acute anterior granulomatous hypertensive uveitis. The patient responded favourably to the withdrawal of the eye drops without showing any subsequent relapse.. Uveitis due to brimonidine is a rare adverse effect, but it must be known. Once the diagnosis is suspected, the effective treatment is the withdrawal of brimonidine, with or without the addition of topical corticosteroids to control inflammation depending on the severity of the condition. It is a process with an excellent prognosis.

Topics: Acute Disease; Adrenergic alpha-2 Receptor Agonists; Aged, 80 and over; Brimonidine Tartrate; Conjunctivitis, Allergic; Cyclopentolate; Drug Therapy, Combination; Epithelium, Corneal; Female; Glaucoma, Open-Angle; Granuloma; Humans; Latanoprost; Lubricant Eye Drops; Ocular Hypertension; Ophthalmic Solutions; Prednisolone; Sulfonamides; Thiophenes; Timolol; Uveitis, Anterior

An 85-year-old male with glaucoma presented with a 1-1/2 year history of tearing; red eyes; and pruritic, edematous, eczematous eyelids. Treatment for presumed ocular rosacea and seborrhea was unhelpful. Patch testing to our standard 64 antigens yielded a positive reaction to Balsam of Peru. Notably, benzalkonium chloride, thimerosal, and other preservatives elicited negative reactions. Repeat open application testing elicited positive results to Xalatan (latanoprost) 0.005% ophthalmic solution (Pharmacia & Upjohn, Kalamazoo, MI). A second session of patch tests to 10 personal products, in addition to Xalatan 0.005% solution and the Xalatan vehicle (provided by the manufacturer), elicited a strong positive reaction only to the full preparation of Xalatan 0.005% solution. This report describes the first known case of ACD to latanoprost, a new prostaglandin analog that is widely prescribed for treatment of glaucoma.

Topics: Aged; Aged, 80 and over; Conjunctivitis, Allergic; Dermatitis, Allergic Contact; Diagnosis, Differential; Glaucoma; Humans; Latanoprost; Male; Ophthalmic Solutions; Patch Tests; Prostaglandins F, Synthetic