Epinastine Eyelid Cream as a Practical Option for Patients With Glaucoma on Multidrug Topical Therapy: A Case Report

Abstract

Patients with glaucoma often require long-term use of multiple ophthalmic medications, which can make adherence to additional treatments, such as anti-allergic eye drops for seasonal allergic conjunctivitis, particularly challenging. Moreover, corticosteroid eye drops or ointments, commonly used to manage ocular allergy, are generally avoided in these patients due to the risk of increasing intraocular pressure. We report a case in which a patient with glaucoma, already undergoing multiple topical therapies, experienced recurrent allergic conjunctivitis and blepharitis each spring. The use of conventional anti-allergic eye drops had limited efficacy due to poor adherence associated with the complexity of the treatment regimen. To address this, a newly introduced epinastine cream was applied to the eyelids once daily as an alternative treatment. Following this change, the patient's allergic ocular symptoms improved substantially, with enhanced treatment compliance and no adverse effects on intraocular pressure during follow-up. This case suggests that non-ocular-drop formulations, such as eyelid creams, may offer a practical and effective approach for managing allergic eye disease in patients with glaucoma who are already on complex topical regimens.

Keywords: adherence; allergic conjunctivitis; epinastine; eye drops; eyelid cream; glaucoma.

Figure 1. Latest ocular findings in a 40-year-old man undergoing glaucoma treatment.

(A) Optical coherence tomography (OCT) images of both eyes showing thinning of the retinal nerve fiber layer. (B) Humphrey visual field test results of both eyes demonstrating marked visual field constriction consistent with glaucoma.

Figure 2. Eyelid findings before and after eyelid cream treatment.

(A) Eyelid findings during treatment with epinastine eye drops, showing marked eyelid dermatitis and allergic conjunctivitis. (B) Eyelid findings two weeks after initiating epinastine eyelid cream, showing clear improvement of blepharitis and conjunctivitis symptoms.