Isolated Allergic Conjunctivitis Induced by an Oral Nonsteroidal Anti-inflammatory Drug (NSAID), Confirmed by an Oral Provocation Test: A Case Report

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a well-known cause of systemic hypersensitivity (urticaria, angioedema, and bronchospasm). Ocular involvement is usually described as merely a component of a systemic reaction. It should be distinguished from the local toxicity of topical ocular NSAIDs. To our knowledge, very few cases of isolated allergic conjunctivitis induced by oral NSAIDs have been reported. We report the case of a 24-year-old woman with no history of atopy, who had presented for the past 7 months with recurrent bilateral asymmetric allergic conjunctivitis, predominantly affecting the right eye and strictly coinciding with her menstrual cycle. Examination revealed reduced visual acuity due to conjunctival chemosis and tearing, at 20/25 (LogMAR 0.10) in the right eye and 20/22 (LogMAR 0.05) in the left eye. Allergy testing, including prick tests and eosinophil counts, did not identify a relevant causative allergen explaining the clinical presentation. A detailed medication history revealed a temporal correlation with oral ibuprofen used for severe dysmenorrhea, without any accompanying cutaneous, respiratory, or systemic symptoms. Upon discontinuation of ibuprofen and its replacement with paracetamol and codeine, no recurrence was observed for four consecutive months, and an oral provocation test performed in the fifth month was positive, with mild conjunctivitis confirming the diagnosis. We report a case of isolated allergic conjunctivitis induced by oral NSAIDs and confirmed by an oral provocation test, which highlights the importance of a systematic review of medication history in all cases of recurrent conjunctivitis and that oral NSAIDs should be considered in the diagnosis of recurrent conjunctivitis.