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Complete atrioventricular block due to ingestion of Visine eye drops
  1. Omar Afify1,
  2. Abdul-Rahman M Suleiman1,
  3. Hassan G Mohamed2 and
  4. Omar Saaed2
  1. 1Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
  2. 2Internal Medicine, Detroit Medical Center/Wayne State University, Detroit, Michigan, USA
  1. Correspondence to Omar Afify; oafify{at}


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.

  • arrhythmias
  • poisoning
  • drug misuse (including addiction)
  • toxicology

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  • Contributors OA and A-RS coauthored the case report. HM and OS reviewed, edited and supervised the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

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