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Medical Mystery: What's causing episodes of red, swollen eyes?

Beth's right eye had first become red and swollen about nine months before she came to see me.

Beth's right eye had first become red and swollen about nine months before she came to see me. During that first episode, she went to the emergency room and was diagnosed with a periorbital cellulitis - an infection involving the tissues around her eye. She was treated with two different antibiotics and also was put on a course of oral steroids (Prednisone). The eye symptoms cleared over the next several days.

A few weeks later, the same symptoms cropped up, and she again went to the emergency room. That visit triggered a series of further visits to medical specialists, including an infectious-diseases doctor, an ophthalmologist, and an ear, nose, and throat doctor. Treatments included a monthlong course of antibiotics and several courses of Prednisone. Yet her periorbital symptoms continued to reoccur, sometimes also involving her left eye.

After nine months, her primary-care doctor recommended she consult an allergist, and she came to my office. After listening to her prolonged history, we performed a test that hadn't yet been tried.


Because her symptoms improved while she was taking steroids but flared up again afterward, we suspected Beth was sensitive to one or more chemicals in the products she used. So we performed a patch test.

Tiny samples of 36 common causes of contact dermatitis were placed on her back and examined after 48 hours, then after 72 hours.

She turned out to be sensitive to balsam of Peru and MI (methylisothiazolinone). These chemicals are used in a variety of products, including shampoos, conditioners, and skin products. It's possible to become sensitized to a chemical even after years of using it without a problem. Allergists and dermatologists are specifically trained to look for such sensitivities, but many physicians miss them.

Once Beth got rid of everything containing these chemicals, her eye swelling no longer occurred.

Persistent and recurrent bilateral periorbital redness, itching, and swelling is frequently caused by a contact dermatitis. The product doesn't even have to get in the eye - just having the residue on the hands and then rubbing the eyes, which are far more sensitive than the skin, can be enough to trigger this often-frustrating problem.

Anthony Rooklin, M.D., is codirector of allergy and immunology at Crozer Medical Center.

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