{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T10:41:24Z","timestamp":1794048084951,"version":"4.8.0"},"reference-count":11,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,4,27]]},"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:p>Visine eye drops are a commonly used topical drug for irritation of the eye. The active component in Visine eye drops is tetrahydrozoline. Tetrahydrozoline is an imidazoline derivative found in several ophthalmic and nasal decongestants. Exposure is common in young children, who unintentionally ingest it, but cases have been rising in the adult population. The main systemic effects are bradycardia and hypotension due to activation of the central alpha-adrenergic receptors. In this case report, a 76-year-old man presents with bradycardia after 24 hours following ingestion of 120 mL of 0.05% tetrahydrozoline (eight bottles of Visine eye drops) in a suicide attempt. His initial ECG demonstrated complete heart block and QT prolongation. Subsequent ECGs showed unremitting first-degree atrioventricular block and QT prolongation. Here, we are presenting the first case of complete heart block following tetrahydrozoline consumption.<\/jats:p>","DOI":"10.1136\/bcr-2021-241905","type":"journal-article","created":{"date-parts":[[2021,5,12]],"date-time":"2021-05-12T13:13:04Z","timestamp":1620825184000},"page":"e241905","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Complete atrioventricular block due to ingestion of Visine eye drops"],"prefix":"10.1136","volume":"14","author":[{"given":"Omar","family":"Afify","sequence":"first","affiliation":[{"name":"Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4540-4741","authenticated-orcid":false,"given":"Abdul-Rahman M","family":"Suleiman","sequence":"additional","affiliation":[{"name":"Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassan G","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Internal Medicine, Detroit Medical Center\/Wayne State University, Detroit, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Saaed","sequence":"additional","affiliation":[{"name":"Internal Medicine, Detroit Medical Center\/Wayne State University, Detroit, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,5,12]]},"reference":[{"key":"2025082700465089000_14.5.e241905.1","doi-asserted-by":"crossref","first-page":"454","DOI":"10.3109\/15563650.2014.898770","article-title":"Significance of the imidazoline receptors in toxicology","volume":"52","author":"Lowry","year":"2014","journal-title":"Clin Toxicol"},{"key":"2025082700465089000_14.5.e241905.2","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/S0736-4679(03)00206-3","article-title":"Are one or two dangerous? clonidine and topical imidazolines exposure in toddlers","volume":"25","author":"Eddy","year":"2003","journal-title":"J Emerg Med"},{"key":"2025082700465089000_14.5.e241905.3","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1016\/0736-4679(95)00071-H","article-title":"Visine overdose: case report of an adult with hemodynamic compromise","volume":"13","author":"Lev","year":"1995","journal-title":"J Emerg Med"},{"key":"2025082700465089000_14.5.e241905.4","doi-asserted-by":"publisher","DOI":"10.3109\/15563650.2013.863906"},{"key":"2025082700465089000_14.5.e241905.5","first-page":"1220","article-title":"Annual report of the American association of poison control centers' national poison data system (NPDS): 36th annual report","volume":"2019","author":"Gummin","year":"2018","journal-title":"Clin Toxicol"},{"key":"2025082700465089000_14.5.e241905.6","unstructured":"Norman K , Nappe TM . Alpha Receptor Agonist Toxicity. StatPearls, 2020. Available: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK500023 [Accessed 5 Dec 2020]."},{"key":"2025082700465089000_14.5.e241905.7","doi-asserted-by":"publisher","DOI":"10.1002\/clc.4960110118"},{"key":"2025082700465089000_14.5.e241905.8","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1977.03280190032022"},{"key":"2025082700465089000_14.5.e241905.9","first-page":"564","article-title":"Sinoatrial node dysfunction following visine ingestion[abstract]","volume":"34","author":"Jones","year":"1996","journal-title":"J Toxicol Clin Toxicol"},{"key":"2025082700465089000_14.5.e241905.10","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1080\/15563650701258070","article-title":"Prolonged cardiovascular effects after unintentional ingestion of tetrahydrozoline","volume":"46","author":"Spiller","year":"2008","journal-title":"Clin Toxicol"},{"key":"2025082700465089000_14.5.e241905.11","doi-asserted-by":"crossref","first-page":"e12","DOI":"10.1016\/j.forsciint.2012.04.004","article-title":"Use of tetrahydrozoline for chemical submission","volume":"221","author":"Stillwell","year":"2012","journal-title":"Forensic Sci Int"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-241905","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T07:46:59Z","timestamp":1756280819000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-241905"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5]]},"references-count":11,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,5,12]]},"published-print":{"date-parts":[[2021,5]]}},"alternative-id":["10.1136\/bcr-2021-241905"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-241905","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5]]}}}