3.8 Conjunctivitis Medicamentosa/Dermatoconjunctivitis Medicamentosa

eyes.nhs.scot/
Eyecare Guidelines/
Section 3 - Conjunctiva/
3.8 Conjunctivitis Medicamentosa/Dermatoconjunctivitis Medicamentosa

Date of revision:

10/04/2026

Date of next review:

10/04/2028

Date of publication:

20/04/2026

Differential diagnosis ⁽¹⁾

Contact lens–related staining or oedema
Corneal erosion, abrasion, or ulcer
Corneal endothelial dysfunction
Ocular rosacea
Viral keratoconjunctivitis
Dry eye or exposure keratitis
Some topical medications (e.g. some prostaglandin analogues, Rho kinase inhibitors) cause hyperaemia as a known side effect and don’t need to be stopped
Rebound hyperaemia from overuse of topical decongestants

Possible management by optometrist

Advice

Identify and stop the offending medication or preservative ⁽¹⁾
Recommend cold compresses to relieve symptoms ⁽¹⁾
Advise the patient to avoid future use of the causative medication or preservative ⁽¹⁾
Be aware of guidance in treatment section below prior to stopping current medication(s) ⁽⁷⁾

Treatment

Switch to an unpreserved formulation of the same medication when available (e.g. preservative‑free glaucoma or dry‑eye therapy) ⁽¹⁾
Do not discontinue an essential medication if doing so poses greater risk than the medicamentosa (e.g. glaucoma treatment). Refer back to the original prescriber for safe alternatives ⁽¹⁾
Provide preservative‑free ocular lubricants for symptomatic relief asrequired ⁽¹⁾ (drops/gel for use during the day ± unmedicated ointment for use at bedtime)⁽⁷⁾. Refer to local formularies for suitable options⁽⁶⁾
For severe cases, and only with the original prescriber’s approval, a brief course (up to 1 week) of preservative‑free topical steroid may be considered ⁽¹⁾

NB. Antihistamines and mast cell stabilizers are not recommended for the treatment of conjunctivitis medicamentosa because they are ineffective in controlling inflammation in type IV hypersensitivity reactions ⁽¹⁾

Typical adult dosage/duration

(Blue text = IP, black text = non-IP)

Prednisolone Sodium Phosphate 0.5% eye drops (preservative free) ^(1,5)(POM): One drop ⁽⁷⁾every 1–2 hours until inflammation is controlled ^(2,3)then reduce frequency; tapering may be required ⁽⁷⁾
Dexamethasone 0.1% eye drops (preservative free) ⁽⁵⁾(POM): One drop ⁽⁷⁾ every 1–2 hours until inflammation is controlled ^(2,3) then reduce frequency; tapering may be required ⁽⁷⁾
Hydrocortisone 3.35mg/ml eye drops (preservative free) ⁽⁶⁾ (POM): One drop ⁽⁷⁾ 2–4 times a day for up to 14 days ^(3,4)then reduce frequency; tapering may be required ⁽⁷⁾

NB. Monitor inflammatory response to steroid and measure IOP regularly during treatment and on completion ⁽⁷⁾

Regimens should be adjusted according to severity and patient factors (e.g. age, weight, pregnancy, renal function). Prescribing should follow local formulary and national guidance where available ⁽⁷⁾.

In cases of known sensitivities, please consult local formularies for alternative options ⁽⁷⁾.

Further management options

Treatment may be provided within available locally enhanced schemes, or by community IP optometrists/OMPs, as appropriate ⁽⁷⁾
Typically, no referral is needed, but the original prescriber should be informed and should guide changes to prescribed therapy ⁽¹⁾

Possible management in secondary care or local/community pathways where available

See Further management options ^{(1, 7)}
No additional routine secondary care interventions - management mirrors the steps above unless local pathways specify otherwise ⁽¹⁾

College of Optometrists Clinical Management Guideline⁽¹⁾

Conjunctivitis medicamentosa (also known as dermatoconjunctivitis medicamentosa) - College of Optometrists

* With special thanks to The College of Optometrists for providing the evidence framework for diagnosis and management from the Clinical Management Guidelines (CMGs) for this condition. All references to the College/CMGs are included where appropriate and form the basis of the Community Eyecare Guidelines.

Guidance is informed by the following sources

College of Optometrists Clinical Management Guidelines Clinical Management Guidelines - College of Optometrists
Advisory alignment with the College of Optometrists Formulary Optometrists' Formulary - College of Optometrists
Advisory alignment with the BNF BNF (British National Formulary) | NICE
Advisory alignment with the Summary Product Characteristics taken from the EMC Home - electronic medicines compendium (emc)
Advisory alignment with Scottish Health Board formularies (where a clear majority is present) *
Advisory alignment with expert consensus (CEGG), informed by sources 2-5 above
Advisory alignment with expert consensus (CEGG)
“Annex C of the Statement” https://www.eyes.nhs.scot/for-professionals/legislation/

* Scottish formularies should be available within the Prescribing section of your Health Board pages on the eyes.nhs.scot website. If unavailable, contact your local Health Board for further information; Health Boards landing page

If you have a query relating to this page, please email NSS.ComEyecareGuidelineGroup@nhs.scot

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CEG disclaimer for guidelines awaiting update:

The Eyecare Guidelines area of the eyes.nhs.scot website (“Website”) is intended as a reference source for education and clinical decision support and is intended for use by ophthalmic healthcare professionals working in Scotland.

As such, the Eyecare Guidelines are not intended for use by the general public and do not replace the advice of a healthcare professional. Members of the public should seek advice directly from their optometrist.

Before reading the Eyecare Guidelines or making any management decisions based upon them, all users should read the ‘supporting information’ page which gives more detail around the content of the Guidelines and useful website links [link to Supporting Information page].

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Users should note that that the Eyecare Guidelines guidance is not mandatory. The guidelines will not be suitable for every situation and they are not intended to be a substitute for specialist expertise and clinical judgement. Users assume all responsibility for using/interpreting the information within the Eyecare Guidelines section of the website. Users should also note that the Eyecare Guidelines should not be adhered to in isolation and should be considered in conjunction with other national and locally available guidance/pathways. 

Updating the Eyecare Guidelines requires a continuous process; the date of the last review for each guideline will be clearly noted on each guideline. Users must consider these dates before using the guidance.

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