Inferior papillary reaction and/or inferior conjunctival staining with fluorescein from topical eye drops. Most notably from IOP-lowering medications, aminoglycosides, antivirals, and preserved drops (especially those containing benzalkonium chloride). With long-term use, usually more than 1 month, a follicular response can be seen with other medications including atropine, miotics, epinephrine agents, and nonaminoglycoside antibiotics. Inferior SPK and scant discharge may be noted.
Usually sufficient to discontinue the offending eye drop. Can add preservative-free artificial tears four to eight times per day. In severe cases, topical steroids can help quiet the conjunctival inflammation and render the eye more comfortable.