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Topical phenylephrine can cause severe systemic reactions

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PORTLAND, Ore. — Phenylephrine 10% applied topically to the eye via pledget can cause severe adverse systemic reactions in LASIK patients, including severe hypertension, pulmonary edema, cardiac arrhythmia, cardiac arrest and subarachnoid hemorrhage, according to surgeons here. They recommend against using phenylephrine to stop ocular bleeding during LASIK.

Frederick W. Fraunfelder, MD, and colleagues here reviewed articles in the peer-reviewed literature, reports provided to the U.S. Food and Drug Administration’ spontaneous reporting system and the National Registry of Drug-Induced Ocular Side Effects. They identified 11 cases of adverse systemic reactions occurring in LASIK patients treated with phenylephrine 10% pledglets to cease ocular bleeding.

The study is published in the October issue of American Journal of Ophthalmology.