Long-term Topical Medications Research Articles

Toxic Keratoconjunctivitis.

Toxic keratoconjunctivitis (TK) is an underrecognized complication of ophthalmic drug use and various environmental or occupational exposures. A detailed history and clinical examination are important to identify the offending agent(s). Common drug-related causes of TK include preservatives in ophthalmic medications, topical antimicrobials, and topical anesthetics. Alternatives to benzalkonium chloride as well as preservative-free formulations should be considered in patients requiring long-term topical medication. More advanced cases of TK may require preservative-free topical steroids and/or antibiotics, and occasionally surgical intervention. Early recognition and appropriate management of TK may help prevent permanent ocular and visual damage.

Cushing Syndrome from Percutaneous Absorption of 1% Hydrocortisone Ointment in Netherton Syndrome

Netherton syndrome is a congenital skin disease associated with decreased skin barrier function and increased percutaneous absorption. We report an 11-year-old boy with Netherton syndrome who developed Cushing syndrome after application of 1% hydrocortisone ointment to his entire body for more than 1 year. This presentation illustrates that even low-potency steroid ointments should be used with caution in Netherton syndrome and warns about the use of long-term topical medications with potential systemic side effects when used in large quantities in any chronic skin disease.

Iatrogenic limbal stem cell deficiency.

To describe a group of patients with limbal stem cell (SC) deficiency without prior diagnosis of a specific disease entity known to be causative of SC deficiency. We performed a retrospective review of the records of all patients with ocular surface disease seen at the University of Minnesota between 1987 and 1996. Patients were categorized according to origin of limbal deficiency. Patients who did not have a specific diagnosis previously described as being causative of limbal deficiency were analyzed. Risk factors, clinical findings, and sequelae were evaluated. Fourteen eyes of 12 patients with SC deficiency not caused by a known diagnosis were described. All eyes had prior ocular surgery involving the corneoscleral limbus. Eleven eyes had been receiving long-term topical medications, and all eyes had concurrent external disease such as pterygium, keratoconjunctivitis sicca, rosacea, herpes simplex virus keratitis, or aphakic or pseudophakic corneal edema. All eyes had superior quadrants affected, corresponding to areas of prior limbal surgery. Sequelae of disease included corneal scarring and neovascularization, with seven eyes having visual acuity of 20/150 or worse. Because the epitheliopathy started peripherally and extended centrally in all patients, we believe it represents an SC deficiency. The fact that all patients were affected superiorly, at sites of a prior limbal surgical incision, points to surgical trauma to the SC as the likely major etiologic factor for the deficiency. The surgical trauma to the limbal SC probably made these cells more susceptible to damage from other external disease influences and toxicity from long-term topical medications. Because the SC deficiency is the result of prior ocular surgery and long-term topical medications, we propose the term "iatrogenic limbal stem cell deficiency."

Okuläres Pseudopemphigoid nach topischer Medikamentenapplikation

BACKGROUND Since it's first description in 1974 by Kristensen and Norn numerous substances have been reported as potential causes for drug-induced pseudopemphigoid. The signs and symptoms are as severe as with ocular cicatricial pemphigoid. It seems to be most important for the visual outcome for how long the inducing drug was applied and how soon it has been stopped after the first signs. PATIENTS Six female patients were investigated. All six patients presented the clinical picture of a cicatricial pemphigoid but this was not confirmed by immunostaining. The average age of these patients was 72.5 +/- 8.1 years. In 5 of these patients topical antiglaucomatous drugs are thought to be the inducing factor. The average interval from the start of medication until the appearance of the first symptoms was 14.8 +/- 5.3 years. CONCLUSIONS. The drug-induced ocular pseudopemphigoid is a serious but rare consequence of long-term topical medication. This potential risk should be carefully balanced against the benefit of long-term topical therapy.

Neuerungen auf dem Gebiet der Konjunktiva 1991

Publications on the subject of conjunctiva in 1991 have been reviewed. Clinical relevant topics have been stressed. In the field of conjunctival affections caused by microorganisms a spectrum of bilateral squamous conjunctival tumors associated with human papillomavirus type 16 were first documented. Chlamydial antibodies cause proliferation of lymphocytes. The peripheral lymphocyte proliferative response to whole chlamydial elementary bodies seems to have a strong correlation between the responses to the Chlamydia trachomatis serotypes B and L1. In the field of impression cytology of the conjunctiva the topographical distribution of ocular surface cells was described. In patients with glaucoma using long-term topical medication, there seem to be significant degrees of conjunctival metaplasia associated with the number of glaucoma medications. These changes in the conjunctival surface may be related to the preservatives in the preparations (benzalkonium compounds). An ultrastructural defect in conjunctiva in recessive dystrophic epidermolysis bullosa may increase the susceptibility of the conjunctiva to minor mechanical trauma. Thus resulting in the bullous and cicatrical changes seen clinically.

Recent developments in the surgical treatment of glaucoma.

Surgical treatment of the glaucomas continues to evolve with the advent of new techniques and adjunct therapies. The modulation of wound healing with antimetabolites has increased the success and predictability of filtration surgery. Silicone tube shunts continue to be developed and improved for use in refractory glaucoma. Preoperative factors, such as long-term topical medications, may contribute to the success or failure of filtration surgery. Early recognition of postoperative complications and effective management of these complications may also enhance the success of filtration surgery. The debate over combined surgical procedures for glaucoma and cataract persists. This article reviews recent developments in the surgical treatment of glaucoma.