Correspondence (letter to the editor): Misuse of Cortisone Eyedrops

For non-ophthalmologists, considering keratoconjunctivitis sicca (KCS, “dry eye“) as the cause of the red eye symptoms is important, not least because of its overwhelming prevalence; pointing out the history of typical KCS symptoms is therefore important. Acute and chronic problems caused by dry eye include irritation, epiphora or dye eyes, a sensation of pressure, stabbing pains, eye strain/tired eyes, a sensation of a foreign body, blurred vision up to loss of visual acuity, and others.

As red eye (whether caused by KCS or owing to other causes) is primarily an exclusion diagnosis, and the specific proof is arrived at by means of genuine ophthalmologic examinations, it makes compelling sense to present red eye—if not as an emergency—electively to an eye specialist.

The association of conjunctival hemorrhage and conjunctival chalasis in dry eye has been confirmed (2), even though this fact has found far too little attention even among eye specialists. Conjunctival bleeds in KCS patients cease reliably as soon as a therapy consisting of artificial tears and eye ointment at night is adhered to daily.

I recently treated a 40 year old man, who over the years had seen me occasionally for chronic KCS-related conjunctival irritation whenever the cortisone eye drops that he used permanently were not sufficient to suppress the troublesome conjunctival reddening. The cause of the severe eye pain that the patient was experiencing at the time was strongly raised intraocular pressure (33/56 mm Hg) with moderate conjunctival irritation and a clear cornea. The cause was undoubtedly the misuse of cortisone eye drops, which had been prescribed by a doctor in the patient‘s family. For completeness‘s sake, it should be mentioned that uncorrected hyperopia and presbyopia cause—in addition to asthenopia—conjunctival irritation as a result of vasodilation, as well as a feeling of eye pressure, headaches, and other general symptoms. This is of differential diagnostic importance in red eye, not least because this constellation of symptoms is very common.