The use of capsaicin in herpes zoster ophthalmicus neuralgia.

The treatment of neuralgia which occurs during and following herpes zoster ophthalmicus is often unsatisfactory. Capsaicin (trans-8-methyl-N-vanillyl-6-nonenamide) is a drug which depletes substance P and may be effective in inhibiting pain. We utilized topical capsaicin to the affected dermatome five times daily for 4 weeks in 6 patients with acute and post herpetic neuralgia. In four cases pain was markedly relieved and narcotic medications were either discontinued or significantly reduced. In two cases, pain was not reduced. Four patients had side effects including burning sensation at the site of the drug administration (4 cases), dermatitis as a result of overuse of the drug (2 cases) and hyperesthesia (1 case). Our results suggest that capsaicin may be a useful therapy for the alleviation of pain in some individuals with herpes zoster ophthalmicus. However, controlled studies are needed to establish these results.

The acute manifestations of ocular cicatricial pemphigoid: diagnosis and treatment.

Seven patients with ocular cicatricial pemphigoid displayed acute inflammatory activity that could not be attributed to secondary bacterial infections, trichiasis, or lagophthalmos secondary to symblepharon. This acute inflammatory activity was manifested either as a localized conjunctival mound that was ulcerated and intensely hyperemic or as diffuse and intense conjunctival hyperemia and chemosis. Acute disease activity developed shortly after conjunctival biopsy in three patients and appeared spontaneously in the other four patients. Conjunctival biopsy specmens disclosed a heavy infiltrate of polymorphonuclear leucocytes within and beneath the conjunctival epithelium in addition to the chronic inflammatory cells typically found in this condition. The acute manifestations of ocular cicatricial pemphigoid cause rapid shrinkage and scarring of the conjunctiva. Systemic corticosteroids suppressed the acute disease activity and prevented additional scarring in all five patients treated.

Diagnosis and treatment of ocular rosacea.

Eighteen patients with ocular rosacea were treated with oral tetracycline which resulted in marked improvement in all patients. Approximately one half of the patients were able to taper and stop the medication without recurrence of symptoms. The remaining have tapered their medication but could not stop without recurrence of symptoms. The majority of the patients in the series had Staphylococcus aureus on their conjunctiva and lids before and after surgery.

Effects of zinc sulfate on Pseudomonas aeruginosa infections and protease in rabbit corneas.

Zinc ions were shown to reversibly inhibit the activity of Pseudomonas protease. Zinc sulfate was more effective topically in preventing corneal perforations by this enzyme than either cysteine or edetate disodium (Na2 EDTA). The reversibility of the enzyme inactivation by zinc sulfate and its efficacy in preventing perforations were used to estimate the duration of the enzyme activity in the cornea. The protease was found to retain its activity in the rabbit cornea for up to two days after intrastromal injection. The extent of corneal destruction in rabbit corneas infected with live Pseudomonas cells was significantly greater in eyes treated with zinc sulfate than in controls, precluding its use in a clinical setting.