Abstract
BackgroundThe aim of this study was to evaluate the rate of periocular allergic skin reactions to topical neomycin, polymyxin B, and dexamethasone (NPD) ophthalmic ointment.MethodsA consecutive patient prospective study was performed. A total of 522 patients who had a procedure involving incision of the periocular skin with subsequent postoperative application of NPD ophthalmic ointment were included. Patients were evaluated for signs of allergy at 1 week postoperatively or prior if the patient had complaints. A periocular allergic reaction was defined as any periocular skin pruritus, erythema, edematous papules, vesicles, or plaques at the site of ointment application beyond that of the typical postprocedure presentation. The patients continued to be monitored for 30 days postoperatively.ResultsOf the 522 patients who completed the study, eight (1.5%) had a definitive periocular allergic contact dermatitis to the NPD ophthalmic ointment. Allergic presentation ranged from postoperative day 3 to 14.ConclusionsThe rate of periocular allergic reactions to NPD ophthalmic ointment is significantly lower than reported in the literature for other topical preparations of neomycin and polymyxin B. The low rate of allergy in this study suggests that NPD ophthalmic ointment can safely be applied to the periocular skin with a very minimal risk of inciting an allergic reaction.
Highlights
The aim of this study was to evaluate the rate of periocular allergic skin reactions to topical neomycin, polymyxin B, and dexamethasone (NPD) ophthalmic ointment
Despite the high rates of sensitization and allergy to neomycin reported in the literature, the results confirmed our anecdotal observation of low allergy rates with NPD ophthalmic ointment
Reports of topical allergic contact dermatitis from neomycin applied in postoperative surgical patients revealed a lower rate ranging from 4 to 5.3%, which more closely approximates the periocular allergic rates observed in this study [11, 12, 16]
Summary
The aim of this study was to evaluate the rate of periocular allergic skin reactions to topical neomycin, polymyxin B, and dexamethasone (NPD) ophthalmic ointment. Neomycin, polymyxin B, and dexamethasone (NPD) ophthalmic ointment contains methylparaben (0.05%) and propylparaben (0.01%), preservative agents that provide antimicrobial activity and prevent biodegradation of the compound. Polymyxin B has a low sensitization rate, and there is not sufficient evidence to discourage its use because subsequent topical exposure to the antigen is unlikely to cause an allergic contact dermatitis [6,7,8]. Neomycin has been identified in the dermatologic literature as having high rates of sensitization due to previous antigen exposure, thereby increasing the susceptibility for an allergic contact dermatitis reaction with each successive contact. Gehrig and Warshaw evaluated neomycin allergy rates from the North American Contact Dermatitis
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