Acute and chronic conjunctivitis due to over-the-counter ophthalmic decongestants

Arch Ophthalmol. 1997 Jan;115(1):34-8. doi: 10.1001/archopht.1997.01100150036004.


Objective: To describe patterns of conjunctivitis caused by ophthalmic decongestants.

Design: Case series.

Setting: Outpatient eye clinic.

Patients: We selected patients with conjunctival inflammation who were using nonprescription decongestant eyedrops, who had no other cause for conjunctivitis, and whose conditions improved after discontinuing the incriminated preparations.

Main outcome measures: Clinical characteristics of conjunctival inflammation and time to resolution of symptoms and signs after discontinuing the use of eyedrops.

Results: Seventy patients (137 eyes) were identified. Preparations containing the vasoconstrictors naphazoline, tetrahydrozoline, or phenylephrine were associated with 3 clinical patterns of conjunctivitis: conjunctival hyperemia (50 cases), follicular conjunctivitis (17 cases), and eczematoid blepharoconjunctivitis (3 cases). Decongestants were used daily for a median of 3 years (range, 8 hours to 20 years) prior to presentation. The median time to resolution of symptoms and signs was 4 weeks (range, 1-24 weeks), and patients remained asymptomatic for a median follow-up of 6 months (range, 0-12 years).

Conclusion: Nonprescription decongestant eyedrops can produce acute and chronic forms of conjunctivitis by pharmacological, toxic, and allergic mechanisms. Once recognized, conjunctival inflammation often takes several weeks to resolve.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acute Disease
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Blepharitis / chemically induced
  • Blepharitis / pathology
  • Chronic Disease
  • Conjunctiva / pathology
  • Conjunctivitis / chemically induced*
  • Conjunctivitis / pathology
  • Eyelids / pathology
  • Female
  • Follow-Up Studies
  • Humans
  • Imidazoles / adverse effects*
  • Male
  • Middle Aged
  • Naphazoline / adverse effects*
  • Nasal Decongestants / adverse effects*
  • Nonprescription Drugs
  • Ophthalmic Solutions / adverse effects
  • Phenylephrine / adverse effects*
  • Vasoconstriction


  • Imidazoles
  • Nasal Decongestants
  • Nonprescription Drugs
  • Ophthalmic Solutions
  • Phenylephrine
  • Naphazoline
  • tetrahydrozoline