Eyelid contact dermatitis occurring 2.5 years after continuous use of the same eye drops

Periorbital contact dermatitis significantly affects patients' quality of life. It occurs more frequently in women with the use of cosmetics. Less commonly, ophthalmic medications may induce eyelid contact dermatitis.1, 2 We present the case of a man who developed periorbital contact dermatitis due to an eye drop that he had been using for over 2 years, as proven by a repeated open application test (ROAT). An 81-year-old man, with no history of atopic dermatitis, sought consultation for a dermatitis affecting all four eyelids that had appeared 3 months prior and had not responded to topical corticosteroids (Figure 1). He had been using Dacudoses eyewash solution (boric acid, sodium borate, and Turkish rose concentrate; SIFI France SAS, France) and Cosidime eye drops (dorzolamide, timolol, mannitol, and hyetellose; Santen, France) continuously for the last 2.5 years. Skin patch tests (PT) were performed according to international guidelines with the European Baseline series (EBS), the Cosmetics Chemotechnique series (Vellinge, Sweden), and his personal products (soap, shampoo, eye drops). Readings on day 2 (D2) and D4 were negative. Although the patient had been reluctant to believe that his regular eye drops could be involved, he agreed to perform a ROAT with Cosidime, which lately turned positive on D10. Cosidime was therefore discontinued and replaced by Geltim ophthalmic gel (timolol; Théa Pharma, France). Eviction of dorzolamide combined with tacrolimus 0.1% ointment resulted in complete healing within a few days, with no recurrence after 4 months. We report a case of palpebral contact dermatitis proven by a positive ROAT to dorzolamide eye drops, despite the patient's previous tolerance for 2.5 years. Identifying the aetiology of eyelid dermatitis is challenging. An eyelid-specific battery was deemed unnecessary compared to patch testing with EBS and personal products in a French prospective study, and ROAT was proven to be an important tool when investigating personal products, especially eye drops.1 Dorzolamide is a thienothio-pyran-2-sulfonamide carbonic anhydrase inhibitor used as a topical treatment for glaucoma. Several cases of periorbital allergic contact dermatitis from dorzolamide have been published in the literature, among which a series of 14 cases reported by Delaney et al.3 They highlighted a rather long time of onset with a median onset time of 10 weeks and a maximum delay of 40 weeks. In summary, our case underlines the importance of not dismissing potential allergens, even if they have been used for a long time, and confirms the essential role of ROAT in evaluating suspected allergens not identified by PTs. Ilaria Matei: Writing – original draft; writing – review and editing; investigation. Valérie Beaulieu: Writing – review and editing; writing – original draft. Saskia Ingen-Housz-Oro: Writing – review and editing; writing – original draft. Haudrey Assier: Writing – original draft; writing – review and editing; investigation. The authors declare no conflicts of interest.