Cosmetic Changes in Eyes Induced by Over-the-Counter Nasal Spray

A 47-year-old man presented with apparent changes in his eyes after using an oxymetazoline hydrochloride-containing over-the-counter nasal spray for nasal congestion. No eye drops were administered. Photographs revealed that the reduced hyperemia and upper eyelid lift occurred 10 minutes after nasal spray inhalation (A, preadministration; B, postadministration). Oxymetazoline, an alpha-adrenergic agonist that stimulates alpha-1 and alpha-2 receptors, is used in nasal sprays for nasal congestion, and eye drops for eye redness or ptosis. This case highlights the need for awareness that intranasal sprays (such as steroids) may have ocular side effects. (Magnified version of Figure A-B is available online at www.aaojournal.org).