Netarsudil Associated Limbal Follicles: A Case Report

Abstract

Primary Open Angle Glaucoma (POAG) is one of the leading causes of irreversible blindness worldwide. Netarsudil, a Rho-kinase inhibitor and norepinephrine transporter, has recently been approved for reducing intraocular pressure (IOP), which is the single most clinically modifiable risk factor for this condition. Here, a case of a 53-year-old female with POAG who developed follicles along the corneal limbus following treatment with Netarsudil eye drops has been reported. The patient had been non-compliant with her POAG treatment for the past five years and presented with diminished vision (right eye greater than left) and raised IOP of 28 mmHg and 26 mmHg in the right and left eyes, respectively. The patient was started on Netarsudil (0.02%) eye drops once daily. After three weeks, the IOP had reduced to 19 mmHg and 18 mmHg in the right and left eyes, respectively; however, the patient still complained of itching and redness. A slit-lamp examination showed few follicular lesions on the limbus. Initial treatment for allergic conjunctivitis was ineffective, leading to a worsening of symptoms. Netarsudil was then discontinued, and dorzolamide was initiated instead, resulting in the resolution of symptoms within one week. The patient continued on dorzolamide without further issues. While Netarsudil is effective in reducing IOP, many of its potential adverse effects may still be unknown due to limited clinical experience. The present case report aims to contribute to the understanding of the safety profile of this drug. More such reports in the future will enhance this knowledge and help clinicians manage similar adverse situations.

Keywords

• adverse drug reaction
• corneal limbus
• glaucoma
• rho kinase inhibitors