Ophthalmic adverse effects of nasal decongestants on an experimental rat model / Efeitos oftálmicos adversos de descongestionantes nasais em modelo experimental com ratos

ABSTRACT Purpose: To investigate the potential effects of chronic exposure to a nasal decongestant and its excipients on ocular tissues using an experimental rat model. Methods: Sixty adult male Wistar rats were randomized into six groups. The first two groups were control (serum physiologic) and Otrivine® groups. The remaining four groups received the Otrivine excipients xylometazoline, benzalkonium chloride, sorbitol, and ethylene diamine tetra acetic acid. Medications were applied into both nostrils twice a day for 8 weeks. Before the rats were sacrificed, epithelial staining, the Schirmer test, and intraocular pressure measurements were performed under ketamine/xylasine anesthesia (50 and 5 mg/kg, respectively). Results: Epithelial defects and dry eye were common findings in all study groups. Cataracts developed in two cases clinically. Histopathological evaluation revealed many different pathological alterations in all parts of the ocular tissues such as corneal edema, polypoid proliferation and hyalinization of the vessel wall, cystic formation of the lens, retinal nerve fiber layer degeneration, and corpora amylacea formation of the lacrimal gland. Conclusions: Prolonged usage of the nasal decongestant xylometazoline and its excipients may cause ophthalmic problems such as dry eyes, corneal edema, cataracts, retinal nerve fiber layer, and vascular damage in rats. Although these results were obtained from experimental animals, ophthalmologists should keep in mind the potential ophthalmic adverse effects of this medicine and/or its excipients and exercise caution with drugs containing xylometazoline, ethylene diamine tetra acetic acid, benzalkonium chloride and sorbitol for patients with underlying ocular problems.

RESUMO Objetivo: Investigar os possíveis efeitos da exposição crônica de descongestionante nasal e seus excipientes em tecidos oculares, utilizando um modelo experimental com ratos. Métodos: Sessenta ratos Wistar adultos machos foram divididos aleatoriamente em seis grupos. Os primeiros dois grupos foram controle (soro fisiológico) e Otrivina®. Os quatro grupos restantes receberam os excipientes de Otrivina, tais como Xilometazolina, Benzalcônio, Sorbitol e Ácido Etilenodiamino Tetracético (EDTA). Os medicamentos foram aplicados em ambas as narinas dos ratos, duas vezes ao dia, durante 8 semanas. Antes que os ratos fossem sacrificados, a coloração epitelial, o teste de Schirmer e a medida da pressão intraocular foram realizados sob anestesia com Ketamina/Xilasina (50 e 5 mg/kg, respectivamente). Resultados: Defeitos epiteliais e olho seco foram achados comuns nos grupos de estudo. A catarata desenvolveu-se clinicamente em dois casos. A avaliação histopatológica revelou a existência de alterações em todas as partes dos tecidos oculares, tais como edema de córnea, proliferação polipoide e hialinização da parede vascular, formação cística da lente, degeneração da camada de fibra nervosa da retina (RNFL) e formação de corpos amiláceos da glândula lacrimal. Conclusões: O uso prolongado do descongestionante nasal Xilometazolina e seus excipientes pode causar vários problemas oftalmológicos, como olho seco, edema de córnea, catarata, RNFL e dano vascular em ratos. Embora esses resultados tenham sido obtidos a partir de animais experimentais, os oftalmologistas devem ter em mente os potenciais efeitos oftalmológicos adversos desse medicamento e/ou de seus excipientes.

Pseudohypopyon after Management of Posterior Capsule Rupture Using Intracameral Triamcinolone Injection in Cataract Surgery

No abstract available.

Rosácea fulminans inducida por corticoides tópicos: Casos clínicos / Rosacea fulminans: report of two cases

Background: Rosacea fulminans is a rare condition, characterized by a sudden onset of papulopustules, cysts, edema, and draining sinuses usually confined to the facial area. It is often accompanied by low-grade fever, myalgias and leukocytosis. Patients usually have a background of mild rosacea. We report two male patients aged 29 and 54 years, presenting with rosacea fulminans and ocular involvement, triggered by the use of topical steroids. Both responded to systemic treatment with corticosteroids, isotretinoin and metronidazole. Rosacea fulminans should be considered as a variant of rosacea that includes papulopustular, ocular, phymatous and erythematotelangiectatic types.

Alterações oftalmológicas decorrentes do tratamento do lúpus eritematoso sistêmico juvenil / Ocular changes due to the treatment of juvenile systemic lupus erythematosus

OBJETIVO: Avaliar retrospectivamente as alterações oftalmológicas de crianças e adolescentes com lúpus eritematoso sistêmico juvenil (LESJ) em um serviço de reumatologia pediátrica terciário. MÉTODOS: Avaliamos 117 pacientes com LESJ (85,5% do gênero feminino, 60,7% não caucasoides) com média de idade de 10,4 anos e média de tempo de evolução da doença de 5,4 anos que preenchiam no mínimo quatro critérios de classificação do LES de acordo com o American College of Rheumatology de 1997. Aplicamos um protocolo que continha dados clínicos e demográficos, queixas e alterações oftalmológicas, idade do início, tempo de uso e dose cumulativa das medicações. RESULTADOS: Dos 117 pacientes, 24 (20,5%) apresentaram alterações oftalmológicas. Destes, 16 apresentaram alteração de fundo de olho associada a hipertensão arterial sistêmica e/ou uso de cloroquina, quatro apresentaram catarata, dois apresentaram glaucoma e dois apresentaram catarata e glaucoma. A média de idade do aparecimento das alterações oftalmológicas foi de 14,1 anos. Os pacientes com alterações oftalmológicas receberam, estatisticamente, maiores doses e tempos de pulsoterapia de glicocorticoide em relação aos pacientes sem alterações oftalmológicas [1,5 (0,4-1,6) versus 1 (0,2-1,6) mg/kg, P = 0,003; 25,7 (2-99) versus 17,8 (1-114) meses, P = 0,0001; respectivamente]. CONCLUSÃO: Verificamos alta prevalência de alterações oftalmológicas relacionadas principalmente ao tratamento do LESJ, o que demonstra a necessidade de avaliações regulares mesmo em pacientes assintomáticos, visando ao diagnóstico e intervenção precoces e à diminuição da morbidade ocular relacionada a essa doença.

OBJECTIVE: To assess retrospectively the ocular changes in children and adolescents with juvenile systemic lupus erythematosus (JSLE) in a tertiary pediatric rheumatology service. METHODS: This study assessed 117 JSLE patients (85.5% female, 60.7% non-Caucasian), who met at least four criteria of the 1997 SLE classification of the American College of Rheumatology. Their mean age was 10.4 years, and their mean time of disease progression was 5.4 years. A protocol containing clinical and demographic data, ophthalmologic complaints and changes, age of onset, duration of medication use, and cumulative medication dose was applied. RESULTS: Of the 117 patients, 24 (20.5%) had ocular changes. Sixteen of them had abnormal fundoscopy associated with systemic hypertension and/or use of chloroquine; four had cataract; two had glaucoma; and two had cataract and glaucoma. The mean age of ocular change onset was 14.1 years. Patients with ocular changes received statistically higher and longer doses of glucocorticoid pulse therapy as compared with patients without ocular changes [1.5 (0.4 to 1.6) versus 1 (0.2 to 1.6) mg/kg, P = 0.003; 25.7 (2-99) versus 17.8 (1-114) months, P = 0.0001, respectively]. CONCLUSION: A high prevalence of ocular changes relating mainly to the treatment of JSLE was observed. This demonstrates the need for regular ophthalmologic examinations even in asymptomatic patients, aiming at the early diagnosis and intervention, and at decreasing the ocular morbidity related to that disease.

Comparison of Clinical Manifestations between Patients with Ocular Myasthenia Gravis and Generalized Myasthenia Gravis

PURPOSE: To compare the clinical manifestations between patients with ocular myasthenia gravis and those with generalized myasthenia gravis (MG). METHODS: The medical records of 71 patients diagnosed with MG between January 1995 and December 2007 were reviewed. Demographics, sensitivities of diagnostic methods, the presence of systemic autoimmune diseases, ophthalmic complications caused by MG, and treatments were evaluated and compared. RESULTS: Fourteen patients (20%) were diagnosed with ocular MG and 57 patients (80%) with generalized MG. Sensitivities of anti-acetylcholine receptor antibody and repetitive nerve stimulation tests were significantly higher in the generalized MG group (84%, 89%) compared to those in the ocular MG group (50%, 54%) (p = 0.011, p = 0.008). The sensitivity of the neostigmine test was the highest in both groups (98% of generalized MG, 79% of ocular MG), and the difference between the two groups was borderline significant (p = 0.058). The most common symptoms were ptosis and diplopia, and both groups presented with pain, blurred vision, and tearing. Systemic autoimmune disease was more prominent in the generalized MG group (21%) than in the ocular MG group (14%), and steroid therapy was used more frequently in the generalized MG group (82%) than in the ocular MG group (57%). Ophthalmic complications associated with long-term steroid treatment were more profound in the generalized MG (30%) compared to those of the ocular MG (21%). CONCLUSIONS: The generalized MG group was associated with higher sensitivities to diagnostic tests, more systemic steroid use, higher ophthalmic complications caused by systemic autoimmune disease, and long-term steroid treatment compared to those of the ocular MG group.

BTEX Exposure and its Health Effects in Pregnant Women Following the Hebei Spirit Oil Spill / 예방의학회지

OBJECTIVES: We evaluated the health effects of exposure to BTEX (Benzene, Toluene, Ethylbenzene, m,p-Xylene, o-Xylene) in the Taean area after the Hebei Spirit oil spill. METHODS: We used a questionnaire survey to look for health effects among 80 pregnant women 2 to 3 months following the Hebei Spirit oil spill. Their BTEX exposures were estimated using the CALPUFF method. We then used a multiple logistic regression analysis to evaluate the effects of BTEX exposure on the women's health effets. RESULTS: Pregnant women who lived near the accident site reported more symptoms of eye irritation and headache than those who lived farther from the site. There was a trend of decreasing symptoms with an increase in distance from the spill site. Pregnant women exposed to higher ambient cumulative levels of Xylene were significantly more likely to report symptoms of the skin (OR 8.01 95% CI=1.74-36.76) in the first day after the accident and significantly more likely to report abdominal pain (OR 3.86 95% CI=1.02-14.59 for Ethylbenzene, OR 6.70 95% CI=1.82-24.62 for Xylene) during the 1st through 4th days following the accident. CONCLUSIONS: This study suggests that exposure to BTEX from an oil spill is correlated with an increased risk of health effects among pregnant women. This implies the need to take proper measures, including the development of a national policy for environmental health emergencies and a plan for studying the short- and long-term chronic health effects associated with such spills.

Corticoides sistémicos: uso racional en dermatología / Systemic glucocorticoids: rational use in dermatology

Los glucocorticoides (GC) son potentes agentes inmunosupresores y antiinflamatorios ampliamente utilizados en el tratamiento de enfermedades dermatológicas. Las complicaciones asociadas a la terapia esteroidal sistémica aumentan con dosis mayores, tratamientos prolongados y administración fraccionada. Para maximizar la eficacia de la terapia esteroidal minimizando el riesgo de efectos adversos, es necesario conocer su farmacocinética y función a nivel de distintos órganos blanco. En esta revisión damos una visión general del mecanismo de acción de los GC y sus efectos adversos, junto con algunas recomendaciones prácticas para su uso clínico efectivo y seguro, disminuyendo el riesgo de desarrollar complicaciones.

(GC) are potent immunosuppressive and anti-inflammatory agents widely used in the treatment of many dermatologic diseases. Complications associated with systemic GC increase with higher doses, prolonged therapies, and divided administration. In order to maximize the effectiveness of steroidal therapy, minimizing the risk of adverse effects, it is necessary to know their pharmacokinetics and function on different target organs. In this review, we take general look at the mechanism of action and side effects of GC, along with some practical recommendations for their safe and effective use in order to decrease the risk of complications.

Pseudohypopyon immediately after intravitreal injection of triamcinolone acetonide: case reports

Descrição de dois casos de pacientes submetidos à injeção intravítrea de acetonida de triancinolona (AT), que desenvolveram pseudo-hipópio transitório. Um paciente apresentava edema macular diabético clinicamente significativo com componente cistóide e o outro, com descolamento seroso de retina agudo com Vogt-Koyanagi-Harada, e ambos desenvolveram pseudo-hipópio com presença de depósitos de cristais no endotélio corneano; em um caso o pseudo-hipópio desapareceu espontaneamente em 24 horas, no outro caso o pseudo-hipópio teve duração de 2 dias. O pseudo-hipópio é importante sinal que pode ser observado após injeção intravítrea de AT, em pacientes fácicos, apresentando resolução espontânea sem complicações. Este pseudo-hipópio causado por depósitos de cristais de AT deve ser considerado diagnóstico diferencial para hipópio infeccioso associado a este tipo de tratamento.

La importancia del estudio oftalmológico en pacientes con lupus eritematoso generalizado o discoide tratados con cloroquina / Ophtalmic examination importance in systemic or dischoid lupus in patients under chloroquine treatment

Realizamos un estudio observacional y prospectivo en 38 pacientes con lupus eritematoso con el propósito de determinar la prevalencia de la retinotoxicidad que puede resultar de la administración diaria de 250 mg de difosfato de cloroquina. Hasta el día del estudio, los pacientes habían recibido una dosis total media de 207.7 mg durante menos de un año (34 por ciento de los casos) hasta un máximo de ocho años. En cinco pacientes observamos alteraciones en el fondo del ojo. Cuatro de estos casos correspondieron a mujeres con diagnóstico de lupus generalizado; una de ellas, por presentar disminución de la visión y pérdida del reflejo foveolar, se consideró como premaculopatía secundaria al uso de la cloroquina; las otras tres pacientes tuvieron tortuosidad arteriolar y cambios en el epitelio pigmentario, pero destaca que una de ellas tenía antecedente de vasculitis retiniana secundaria a la enfermedad. El quinto caso con alteracion en el fondo del ojo correspondió a una enfermedad con lupus discoide; presentó tortuosidad arteriolar y pequeños cambios en el epitelio pigmentario. Ningún caso mostró datos positivos para malculopatía secundaria a cloroquina en la fluorangiografía. Recomendamos efectuar estudio oftalmológico antes y durante la administración de este medicamento en pacientes con lupus eritematoso, a fin de detectar casos reversibles de retinotoxocidad, como es la premaculopatía, o bien, cambios retinianos atribuibles al lupus

Induction of vitreolysis and vitreous detachment with hyaluronidase and perfluoropropane gas

To simulate the posterior vitreous detachment (PVD) in the rabbit, 1 IU hyaluronidase and/or 0.2 ml of perfluoropropane gas was intravitreally injected. Ophthalmoscopic, light microscopic examination prepared by cryotechnique, electron microscopic examination, and electroretinogram were done on the 3rd and 28th postoperative days. As a result, the eyes undergone simultaneous intravitreal injection of 1 IU hyaluronidase and 0.2 ml perfluoropropane gas showed membranous structure split from the internal limiting membrane of the superior retina in 3 days after injection. The eyes also demonstrated membranous structure separated from the superior retina after 28 days, simulating vitreous detachment. On the contrary, neither agent alone induced vitreous detachment. No toxic retinal changes associated with simultaneous intravitreal injection of 1 IU hyaluronidase and 0.2 ml perfluoropropane gas were observed. Therefore, with a future support by histologic examination other than cryotechnique and by immunohistochemical analysis, the simultaneous intravitreal injection of perfluoropropane gas and hyaluronidase would be a promising method to induce vitreous detachment in non-vitrectomized eye.

The spectrum of isolated ocular reactions following intravascular contrast administration.

Five out of 2930 (0.2%) consecutive patients developed ocular adverse reactions following intravascular administration of sodium-meglumine diatrizoate. The adverse reactions included bilateral blurring of vision (2), unilateral orbital oedema (2) and bilateral intense conjunctival congestion (one patient). The latter two phenomena responded to steroid and antihistaminic agents. Contrast medium-induced ocular anaphylactoid response is rare but clinically significant.

Chronic ocular lesions in Bhopal gas tragedy.

A comprehensive eye checkup programme was carried out in 1140 cases of affected community to evaluate the exposure response and exposure effect with Methyl Isocynate on human eyes. The final evaluation of these cases was made with standard control group of same socioeconomic status in a non-gas affected slum area of Bhopal. The main chronic lesions noticed were chronic conjunctivitis, refractive changes, deficiency of tear secretion and persistent corneal opacities of various forms.