Association for Research in Vision and Ophthalmology

Association for Research in Vision and Ophthalmology

Issue: June 25, 2017
May 12, 2017
1 min read

Topical non-preserved steroid may help relieve symptoms of preservative-related punctal congestion

Issue: June 25, 2017
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BALTIMORE — Treatment of preservative-related punctal congestion consists of removing all preservative exposure, and a topical non-preserved steroid may help improve symptoms by decreasing conjunctival inflammation and punctal congestion during preservative toxicity washout, according to a study presented here.

Ninety patients with epiphora and punctal stenosis were identified, and 13 (14%) had preservative-related punctal congestion.

The 13 patients had associated chronic conjunctivitis and used preserved drops.

“The common factor in all of these patients was benzalkonium chloride in higher concentrations of at least 0.01% associated with tyloxapol, a surfactant in contact lens solutions,” Thalmon Campagnoli, MD, said in an interview with

Epiphora occurred for an average of 3.8 months before patient presentation, at which point patients were taken off all preserved drops and ointments.

Sixty-nine percent of patients were treated with Lotemax (non-preserved loteprednol etabonate 0.5%, Bausch + Lomb) taper.

By 1.6 months on average, partial symptom relief was achieved, with near complete or complete resolution by 2.6 months.

Usually the symptoms presented at 1 month to 7 months after starting to use the drops, and the patients were using the drops for indications such as conjunctivitis, blepharitis, uveitis, and intra- or periocular surgery, Campagnoli explained.

“We only resolved the symptoms and inflammation after we truly took them off steroid or combination drops,” he said.

The 69% of patients on Lotemax saw complete symptom improvement from congestion, inflammation and epiphora. The 31% of patients who did not use the ointment naturally improved over time as well.

The resolution of conjunctival inflammation was slower than that of epiphora. – by Abigail Sutton


Campagnoli T, et al. Presumed preservative-related punctal congestion. Presented at: Association for Research in Vision and Ophthalmology annual meeting; May 7-11, 2017; Baltimore.

Disclosure: The researchers report no relevant financial disclosures.