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Contact dermatitis caused by latanoprost‐containing eye drops with good tolerance to bimatoprost eye drops

The drugs most frequently used for glaucoma are topical beta blockers such as timolol and levobunolol and miotic agents such as brimonidine. Most recently, prostaglandin analogues such as latanoprost and bimatoprost have been introduced. All these drugs and some vehicles used in their formulation may be responsible for hypersensitivity symptoms (1–3). We present the case of a 48-yearold woman referred to our outpatient clinic with ocular itching, erythema, tearing, and eyelid eczema for one year. Her symptoms were mild but continuous, without seasonal variation. She did not use cosmetics. She denied respiratory symptoms. She had been diagnosed with open angle glaucoma 2 years ago, and she was having treatment with levobunolol 0.5% (Betagan ; Allergan, Santiago, Spain), brimonidine 0.2% (Alphagan ; Allergan), and latanoprost 0.005% (Xalatan ; Pfizer, Madrid, Spain). She had no other medical problems and was on no medication. Patch tests with commercial baseline antigens (True Test ; Alk Abelló, Madrid, Spain), all 3 topical drugs, bimatoprost 0.03% (Lumigan ; Allergan), and additives such as benzalkonium chloride, sulfites, and polyvinyl alcohol were performed. Non-standard antigens and drugs were tested with Curatest (Lohmann–Rauscher, Rengsdorf, Germany). Pure latanoprost was not tested because of its temperature lability. 3 patients who had no previous contact with these drugs were tested as controls. Baseline patch tests were positive only for cobalt chloride at 2 days. Brimonidine, bimatoprost, sulfites, polyvinyl alcohol, and benzalkonium chloride tests were negative. Levobunolol and latanoprost patches were positive at 2 and 4 days. Antiglaucoma treatment was stopped for one month under ophthalmologic supervision. Topical ketotifen was prescribed complete resolution of the symptoms. Levobunolol and latanoprost were reintroduced separately with a recurrence of the symptoms in 2–3 days in both cases. Later, therapy with bimatoprost and brimonidine was tolerated well. Discussion