EC Ophthalmology

Topical phenylephrine, an alpha-1 adrenergic receptor agonist, is commonly used to induce pupillary dilation. While generally considered safe, there are reports of systemic effects even with topical administration. This case report details a 66-year-old female who experienced hypertensive urgency following the administration of topical phenylephrine 2.5% combined with tropicamide 1% during a routine diabetic eye examination. The patient, with a medical history of hypothyroidism managed with Levothyroxine, presented with chills and a sensation of cold shortly after administration of phenylephrine. Her blood pressure increased to 212/103 mmHg, followed by further elevated readings and the onset of chest pain, necessitating emergency medical intervention. In the emergency department, a cardiac workup revealed no significant findings, and the patient was treated for hypertensive urgency and diagnosed with an allergic reaction to phenylephrine. This case highlights the potential for severe systemic reactions to topical phenylephrine, emphasizing the need for vigilance and preparedness in managing such adverse events in clinical practice. Documentation and awareness of these rare but significant side effects are crucial for ensuring patient safety and improving drug safety profiles.

 Keywords: Topical Phenylephrine; Hypertensive Urgency

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