{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:35:01Z","timestamp":1787016901928,"version":"build-2736575974"},"reference-count":14,"publisher":"BMJ","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ Case Reports"],"published-print":{"date-parts":[[2009]]},"abstract":"<jats:p>Phenylephrine 10% is used for pupillary dilatation and capillary decongestion. It had been advised to use a 2.5% concentration instead of 10% to guard against systemic reactions. Here, a case of severe systemic manifestation following conjuctival application of 2.5% phenylephrine is described.<\/jats:p>\n                  <jats:p>A healthy adult was admitted for pterygium excision under ophthalmic blockade. Vital signs remained normal until a sponge soaked with phenylephrine 2.5% was applied over the excised pterygium to control bleeding. The patient developed bradycardia (heart rate of 30 bpm) and hypotension (pressure 80\/40 mmHg), so intravenous atropine was given. This was followed by tachycardia (heart rate of 150 bpm) and hypertension (pressure 240\/130 mmHg) and ECG showed ischaemic changes. Treatment included propofol, labetalol, frusamide, morphine and dexamethasone. The next day, a 12-lead ECG showed no ischaemic changes and the myocardial infarction screen was negative. Fundus examination showed no sign of papilloedema. This report emphasises that phenylephrine 2.5% is still dangerous, with unpredictable response.<\/jats:p>","DOI":"10.1136\/bcr.08.2008.0795","type":"journal-article","created":{"date-parts":[[2009,3,2]],"date-time":"2009-03-02T12:07:46Z","timestamp":1235995666000},"page":"bcr0820080795","source":"Crossref","is-referenced-by-count":8,"title":["Ocular phenylephrine 2.5% continues to be dangerous"],"prefix":"10.1136","volume":"2009","author":[{"given":"Nauman","family":"Ahmed","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waleed","family":"Riad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah","family":"Altorpaq","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdul","family":"Zahoor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2009,3,2]]},"reference":[{"key":"2025042507294064000_2009.mar01_1.bcr0820080795.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9394(02)01591-X"},{"key":"2025042507294064000_2009.mar01_1.bcr0820080795.2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.142.13.2293"},{"key":"2025042507294064000_2009.mar01_1.bcr0820080795.3","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200003000-00030"},{"key":"2025042507294064000_2009.mar01_1.bcr0820080795.4","doi-asserted-by":"publisher","DOI":"10.1001\/archopht.1986.01050200095058"},{"key":"2025042507294064000_2009.mar01_1.bcr0820080795.5","doi-asserted-by":"publisher","DOI":"10.1001\/archopht.1986.01050200098059"},{"key":"2025042507294064000_2009.mar01_1.bcr0820080795.6","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1038\/eye.1997.239","article-title":"A comparative study of the efficacy of 2.5% phenylephrine and 10% phenylephrine in pre-operative mydriasis for routine cataract surgery","volume":"11","author":"Symons","year":"1997","journal-title":"Eye"},{"key":"2025042507294064000_2009.mar01_1.bcr0820080795.7","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1038\/eye.1998.252","article-title":"Comparison of the cardiovascular effects of 2.5% phenylephrine and 10% phenylephrine during ophthalmic surgery","volume":"12","author":"Malhotra","year":"1998","journal-title":"Eye"},{"key":"2025042507294064000_2009.mar01_1.bcr0820080795.8","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1016\/0002-9394(85)90371-X","article-title":"Possible cardiovascular effects secondary to topical ophthalmic 2.5% phenylepherine","volume":"99","author":"Fraunfelder","year":"1985","journal-title":"Am J Ophthalmol"},{"key":"2025042507294064000_2009.mar01_1.bcr0820080795.9","doi-asserted-by":"publisher","DOI":"10.1017\/S0265021507002785"},{"key":"2025042507294064000_2009.mar01_1.bcr0820080795.10","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/0002-9394(85)90229-6","article-title":"Systemic absorption and cardiovascular effects of phenylepherine eyedrops","volume":"99","author":"Kumar","year":"1985","journal-title":"Am J Ophthalmol"},{"key":"2025042507294064000_2009.mar01_1.bcr0820080795.11","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1089\/jop.1990.6.243","article-title":"Review: systemic absorption of topically applied ocular drugs in humans","volume":"6","author":"Salminen","year":"1990","journal-title":"J Ocul Pharmacol"},{"key":"2025042507294064000_2009.mar01_1.bcr0820080795.12","doi-asserted-by":"publisher","DOI":"10.1001\/archopht.1987.01060100066027"},{"key":"2025042507294064000_2009.mar01_1.bcr0820080795.13","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/88.3.440"},{"key":"2025042507294064000_2009.mar01_1.bcr0820080795.14","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1007\/BF03013044","article-title":"Prevention of hypotension after propofol for rapid sequence intubation","volume":"8","author":"Gin","year":"1996","journal-title":"Can J Anaesth"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr.08.2008.0795","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T10:29:50Z","timestamp":1745576990000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr.08.2008.0795"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009]]},"references-count":14,"alternative-id":["10.1136\/bcr.08.2008.0795"],"URL":"https:\/\/doi.org\/10.1136\/bcr.08.2008.0795","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009]]}}}