What are the main ocular side effects associated with ROCK inhibitors?

• A. Conjunctival hyperemia
• B. Corneal verticillata
• C. Conjunctival hemorrhage
• D. Conjunctival hyperemia, corneal verticillata, conjunctival hemorrhage, pain with instillation

Answer: (D)

Rock inhibitors can affect several parts of the ocular surface, leading to a set of common local side effects. Conjunctival hyperemia is the most frequent finding, caused by dilation of the conjunctival vessels after the drug acts on ocular tissues. Corneal verticillata refers to whorl-like deposits in the corneal epithelium that can appear with this drug class. Conjunctival hemorrhage can occur from fragile superficial vessels and minor trauma during drop administration. Pain with instillation is a sign of ocular surface irritation that some patients experience when the drop is put in. Because this well-described profile includes all four effects, the option listing all of them best captures the main ocular side effects associated with ROCK inhibitors. Choices mentioning only one or two of these effects omit parts of the known side-effect spectrum.