Several cases of sudden, irreversible blindness have been reported in the world literature following injections of various drug combinations in the head and neck. The common feature these drugs have is their capacity to either produce direct neurotoxic effects or embolic phenomena. Two new cases which resulted from injection of the combination of a depo or long-acting corticosteroid (methylprednisolone acetate, 40 mg) and a local anesthetic and epinephrine or penicillin were added to the growing world literature. The ocular and systemic pathologic findings are described and important questions are raised as to the pathophysiology. The need for an animal model experiment to answer as many of these questions as possible is emphasized.

The sudden occurrence of unilateral and bilateral blindness, as reported in the literature from the personal experiences of numerous qualified investigators, occurring in humans and producing such catastrophic effects seems to mandate experimental effort to try and answer three basic questions: (1) Can an animal model be found which will demonstrate similar retinopathy for study? (2) If such a model is found, what mechanisms are involved in the production of the retinal pathologic changes? (3) What are the characteristics of the drug or drug combinations necessary to produce these pathologic changes?

Specialist Miss Elisabetta Scoppettuolo answers questions posed by GP Dr Laurence Knott on treating conjunctivitis and comments on two case histories. Copyright © 2006 Wiley Interface Ltd

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