Dermatitis de contacto alérgica palpebral bilateral debida a timolol

Resum

Clinical case: A 72-year-old female patient diagnosed 6 years ago with primary open-angle glaucoma (POAG) in both eyes, treated with latanoprost 0.005% in a single-dose container once a day. In September 2018 there was a slight progression in the visual field (CV) and in the optical coherence tomography (OCT), so the treatment was modified by a fixed combination in multi-dose container travoprost 40 micrograms/ml + timolol 5 mg/ml once a day. In October he consulted because he presented with conjunctival hyperemia, stinging, and in both eyes eyelid inflammation, which improved after stopping treatment. These episodes happened again when using a multi-dose container system with abak, dorzolamide 20 mg/ ml plus timolol 5 mg/ml twice a day, or a fixed combination in single- dose container tafluprost 15 micrograms/ml plus timolol 5 mg/ml once a day. Tolerance tests are carried out on all the prescribed active ingredients, using the mencionated drops, for epicutaneous, being negative to alergy in 48 hours. The conjunctival provocation test was positive at 12 o’clock for 0.5% timolol maleate. Discussion: The sensitization to timolol contained in the ophthalmic drops used to control glaucoma seems to be the responsible mechanism for the patient’s clinical picture. The performance of a tolerance test to the antiglaucomatous active ingredients may be helpful in improving the tolerance to medical treatment of some patients, even avoiding laser and/or precipitate antiglaucomatous surgeries