Article Text

Download PDFPDF
Original article
The ophthalmic side-effects of imiquimod therapy in the management of periocular skin lesions
  1. Paul S Cannon1,
  2. Brett O'Donnell2,
  3. Shyamala C Huilgol3,
  4. Dinesh Selva1
  1. 1Discipline of Ophthalmology & Visual Sciences, University of Adelaide and South Australian Institute of Ophthalmology, Adelaide, Australia
  2. 2Department of Ophthalmology, Royal North Shore Hospital and St Vincent's Hospital, Sydney, Australia
  3. 3Department of Dermatology, Royal Adelaide Hospital & University of Adelaide, Adelaide, Australia
  1. Correspondence to Dr Paul S Cannon, Discipline of Ophthalmology & Visual Sciences, South Australian Institute of Ophthalmology, Adelaide, SA 5000, Australia; pscan05{at}


Aim To describe the ophthalmic side-effects of topical imiquimod for periocular actinic keratoses, squamous cell carcinoma in situ and basal cell carcinoma.

Method A retrospective study was carried out in two centres of all patients who underwent topical imiquimod therapy between January 2004 and January 2009. Imiquimod was applied three times weekly for 4–6 weeks. Diagnosis of the lesions, complications, clinical resolution and long-term ophthalmic side-effects was recorded. Patients on therapy were reviewed fortnightly and then every 6 weeks following completion of treatment.

Results 47 patients were identified; the mean age was 74 years. 37 patients had actinic keratoses, seven patients had Bowen disease, and three patients had BCC. The lower lid was the commonest site involved (68%). Application site erythema occurred in all patients. Conjunctivitis occurred in 15 patients, and six patients complained of ocular stinging on application of imiquimod. One patient had a staphylococcal keratitis, which responded to topical antibiotic and steroid therapy. Two patients required oral antibiotics for preseptal cellulitis. Three patients had delayed conjunctivitis at a mean of 2.3 weeks. Nine patients discontinued imiquimod due to ocular irritation and conjunctivitis, of whom four patients recommenced and finished the treatment after a rest period. At a mean follow-up of 16 weeks, 34 patients had clinical resolution of the periocular lesions and no patient had any residual ophthalmic side-effects from imiquimod.

Conclusion Conjunctivitis and ocular stinging were the commonest ophthalmic side-effects encountered with the application of imiquimod for periocular skin lesions. These effects were temporary and resolved on terminating the imiquimod therapy.

  • Imiquimod
  • periocular skin lesions
  • complications
  • ophthalmic side-effects
  • tolerance
  • neoplasia
  • eye lids
  • drugs

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding PSC received funding from the Royal College of Ophthalmologists, the Dickinson Trust, Pfizer and the Ethicon Foundation for Ophthalmic Fellowship training in Adelaide.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval The Royal Adelaide Hospital granted ethical approval.

  • Provenance and peer review Not commissioned; externally peer reviewed.