Etiological diagnosis of acute drug contact allergic reaction occurred during ophthalmic surgery

Abstract

Drug allergy is one of the most common problems in clinical medicine including ophthalmology. The frequency and severity of drug-induced eye lesions continuously increase as the arsenal of active drugs increases. Among the common causes of eye contact allergy, along with traditionally noted antibiotics and anesthetics, an expanded list of the most remarkable drug allergens, including mydriatics (tropicamide and phenylephrine), beta blockers, dorzolamide, latanoprost, and topical corticosteroids, have been registered recently. In addition to active ingredients, ophthalmic preparations contain various auxiliary substances, such as benzalkonium chloride, chlorhexidine, and thiomersal, which possess sensitizing properties. This study presents a clinical case of a patient suffering from cataracts who developed an acute local allergic reaction during the introductory period of lens replacement surgery, resulting in the cancelation of surgical intervention. In addition, several drugs are used simultaneously, each of which can cause allergies and excipients in their composition. Approaches to specific diagnostics including the choice of skin tests are described depending on the clinical phenotype of drug allergy. After determining the cause of allergy, recommendations are given to the patient and ophthalmologist for further treatment, enabling the subsequent performance of the operation without complications.