Epimax-Related Bilateral Ocular Surface Toxicity: Case Series

Epimax-Related Ocular Surface Toxicity (EROST) emerges as a newly recognised complication stemming from the periocular use of Epimax emollient in managing eczema, leading to bilateral epithelial corneal defects. Prior reports on EROST have primarily described clinical features limited to bilateral corneal epithelial erosions. This study aims to highlight on this condition by presenting three severe cases of bilateral Epimax-related ocular toxicity leading to vision-threatening complications, as a result of these 3 patients using Epimax cream periocularly for eczema. Thus, expanding the understanding and necessitating heightened awareness of EROST.

We report this case series at the Norfolk and Norwich University Hospital NHS Foundation Trust, United Kingdom

We report a retrospective case series of three patients with bilateral ocular surface toxicity attributed to the use of topical Epimax periocularly of varying severities. We report clinical presentations, history of Epimax use, and ocular examination results. Treatment was tailored to disease severity, encompassing both conservative and surgical interventions.

 Included in the study were a (1) 25-year-old female with bilateral corneal epithelial defects, who fully recovered after discontinuing Epimax use; (2) a 64-year-old male with pityriasis rubra pilaris who progressed to bilateral limbal stem cell failure and was treated with an amniotic membrane graft and limbal stem cell transplant in one eye; and (3) 34-year-old male who suffered from bilateral corneal ulcers and underwent emergency corneal gluing for a corneal perforation in the left eye. All patients presented with eye pain, photophobia, and vision impairment. Clinical assessments revealing varying degrees of bilateral involvement. The management strategies were individually tailored.

This case series emphasise the strong correlation between periocular Epimax application and the development of severe bilateral ocular surface toxicity, marking an important addition to the spectrum of EROST. The recovery observed in the 25-year-old patient underscores the potential for reversal of symptoms upon early intervention and discontinuation of Epimax. These findings stress the critical need for patient education on the risks of Epimax emollient use near the eyes and for healthcare professionals to remain vigilant about the possibility of ocular complications in such patients, providing guidance to prevent adverse outcomes.