Supplementary Material for: Bromfenac with Sodium Bisulfite Inducing Contact Dermatitis and Corneal Ring Infiltrate: A Case Report

Introduction: To report a case of bromfenac with sodium bisulfite preservative induced contact dermatitis and a secondary sterile corneal ring infiltrate. Case presentation: A 44-year-old male presented with a one-week unilateral periocular dermatitis and eye redness. Initially the dermatitis responded to oral prednisone 80mg and subsequent taper over two weeks. Upon tapering the prednisone, the patient returned with a recurrent dermatitis a week later. Dermatological work up included a skin biopsy demonstrating spongiotic dermatitis and a skin panel allergy test positive for sodium metabisulfite. The patient later mentioned self-administering bromfenac ophthalmic eye drops that contained sodium bisulfite. After the prolonged bromfenac use the patient also developed a sterile corneal ring ulcer. The dermatitis finally resolved after discontinuing the bromfenac ophthalmic drops, however the ring ulcer persisted after three months. Conclusion: Topical bromfenac ophthalmic drops may induce a severe contact dermatitis related to the inactive ingredient sodium bisulfite within the solution. Chronic use of the bromfenac may also cause a sterile ring infiltrate. Caution should be given to patients in using eye drops with sulfite sensitivity or allergy.