- Grace L Paley: Department of Ophthalmology and Visual Sciences (G.L.P., A.J.L.), Washington University in St. Louis, St, Louis, MO; and Department of Ophthalmology and Visual Science (J.J.R., A.V.F.), University of Chicago, Chicago, IL.
Toxic keratoconjunctivitis (TK) is an underrecognized complication of ophthalmic drug use and various environmental or occupational exposures. A detailed history and clinical examination are important to identify the offending agent(s). Common drug-related causes of TK include preservatives in ophthalmic medications, topical antimicrobials, and topical anesthetics. Alternatives to benzalkonium chloride as well as preservative-free formulations should be considered in patients requiring long-term topical medication. More advanced cases of TK may require preservative-free topical steroids and/or antibiotics, and occasionally surgical intervention. Early recognition and appropriate management of TK may help prevent permanent ocular and visual damage.