Abstract
*Correspondence, David Lockington: davidlockington@hotmail.com
Introduction In September 2021, NHS Greater Glasgow and Clyde’s formulary committee changed the first-line emollient management of atopic eczema to Epimax cream/ointment (Aspire Pharma). In early 2022 we realised some dermatology patients were presenting to ophthalmology with unexplained ocular surface toxicity, possibly related to their changed dermatological preparations.
Methods A retrospective case-note review of emergency eye clinic attendance involving such clinical presentations was undertaken to investigate this phenomenon.
Results We identified 37 patients with atopic eczema between January to October 2022 who attended with novel ocular surface toxicity, related in time-period to Epimax initiation (12 male, 25 female; median age 42 years (range 8–95)). Most reported subjectively reduced VA, frequently associated with photophobia (89.2%). Clinical findings included bilateral involvement (67.6%), with conjunctival injection (97.3%), corneal staining (97.3%), and corneal oedema (27%).
Following diagnosis, most patients received topical lubricants (86.5%), topical antibiotics (73%) and topical steroids (64.9%). Mean visual acuity improvement in affected eyes was 15.8 EDTRS letters by first follow-up appointment (average 7.3 days (range 2–34)). No geographic clustering was identified on postcode analysis.
Conclusions We report the first large case-series of patients with eczema experiencing novel ocular surface toxicity, related to periocular Epimax application following changing formulary recommendations. These mild ocular chemical injuries resolved with cessation of use and topical lubricants and steroids. Dermatology patients should be strongly advised to avoid periocular application of Epimax, and primary care physicians, ophthalmologists and dermatologists made aware of this potential complication.
