Adverse external ocular effects of topical ophthalmic medications

Wilson, Fred M.

doi:10.1016/0039-6257(79)90125-5

Cited by 167 publications

(54 citation statements)

References 117 publications

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“…Topical sulfonamides should be used with caution until new clinical trials demonstrate their efficacy. In addition, sulfonamides and neomycin are commonly associated with hypersensitivity reactions, and sulfonamides are extremely irritating to the conjunctiva (13,23). For H. influenzae, the two aminoglycosides tobramycin and gentamicin were more active than the neomycin combination but not as active as polymyxin-trimethoprim.…”

Section: Discussionmentioning

confidence: 99%

Increasing Bacterial Resistance in Pediatric Acute Conjunctivitis (1997–1998)

Block

Hedrick

Tyler

et al. 2000

Antimicrob Agents Chemother

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We sought to determine the current level of resistance in Haemophilus influenzae and Streptococcus pneumoniae, the primary pathogens of pediatric conjunctivitis. Between January 1997 and March 1998, we prospectively cultured acute conjunctivitis in 250 ambulatory pediatric patients from rural Kentucky whose average age was 24.3 months. In those 250 cases, 106 H. influenzae (42% of the total) and 75 S. pneumoniae (30% of the total) pathogens were isolated, with no growth or no pathogen resulting in 79 cases (32% of the total). Beta-lactamase was detected in 60 (69%) of 87 tested strains of H. influenzae. Among 65 isolates of S. pneumoniae tested for penicillin susceptibility, 44 (68%) were susceptible, 17 (26%) were resistant, and 4 (6%) were intermediate. Conjunctivitis with acute otitis media was observed in 97 patients (39%), and H. influenzae was recovered in 57% of these 97 cases. As for in vitro activity, ciprofloxacin, ofloxacin, and tetracycline were the most active; and gentamicin, tobramycin, polymyxin B-trimethoprim, and polymyxin B-neomycin were intermediately active. Sulfamethoxazole possessed no activity against either pathogen. Beta-lactamase production was detected in 69% of H. influenzae strains, which still remains the primary causative pathogen of both conjunctivitis and conjunctivitis-otitis syndrome. Penicillin-nonsusceptible S. pneumoniae was observed in 32% of 65 patients with S. pneumoniae conjunctivitis, with most strains being penicillin resistant.Acute conjunctivitis is the most common ocular infection in childhood, usually affecting children younger than 6 years old with a peak incidence between 12 and 36 months (3). Pediatric acute conjunctivitis is diagnosed by clinical signs of ocular purulent discharge or hyperemia of bulbar conjunctiva. The etiology of this infection has been documented as bacterial in 54 to 73% of pediatric cases (3,20). The pathogens predominantly recovered include nontypeable Haemophilus influenzae (44 to 68% of cases) and Streptococcus pneumoniae (7 to 21% of cases). Concomitant infection with acute otitis media (AOM) has been coined the conjunctivitis-otitis syndrome by Bodor (4) and is associated with H. influenzae in 20 to 73% of cases and with S. pneumoniae in 12 to 20% of cases (4, 10). Other rare bacterial pathogens of conjunctivitis include Moraxella catarrhalis, Streptococcus mitis, and Streptococcus pyogenes (10,22).Clinicians nearly always empirically treat acute conjunctivitis with topical antimicrobial therapy. The disease is mild, cultures are rarely obtained because of expense, and culture results are reported days later (13). Compared with placebo, topical therapy with polymyxin-bacitracin ointment has been shown to reduce by half the duration of symptoms and to achieve a 2.5-fold increase in rate of bacteriologic eradication at days 8 to 10 (31 versus 79%, respectively) (6). Furthermore, selecting among the multitude of available topical antimicrobials to treat conjunctivitis has been based on either sparse in vitro data or on earlier limited c...

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Section: Discussionmentioning

confidence: 99%

Increasing Bacterial Resistance in Pediatric Acute Conjunctivitis (1997–1998)

Block

Hedrick

Tyler

et al. 2000

Antimicrob Agents Chemother

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“…4,5 The clinical signs of both iatrogenic and factitious disease are usually nonspecific and identical to those resulting from other causes of corneal epithelial disease such as punctate keratopathy, coarse focal keratopathy, pseudodendrites, filamentary keratopathy, and persistent epithelial defect. More specific signs occur with the preservative phenylmercuric nitrate toxicity, 1 which may produce band keratopathy.…”

Section: Diagnosis Of Toxicitymentioning

confidence: 99%

“…A comprehensive clinical study of this problem was carried out 20 years ago and, although drug usage has changed, it remains a very useful account of the epidemiology of the iatrogenic effects of topical medications. 4,5 Table 2 summarises the findings of this study, which was conducted in a tertiary referral centre, where 134/1024 (13.09%) of consecutive cases were classified as drug reactions. 1 Corneal involvement occurred in 119/134 (88%) of these cases and 38 (28%) had frank corneal epithelial defects or indolent ulcers.…”

Section: Epidemiologymentioning

confidence: 99%

Corneal toxicity: the epithelium and stroma in iatrogenic and factitious disease

Dart

2003

Eye

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Corneal toxicity is caused by chemical trauma and by iatrogenic and factitious disease, which are often overlooked, and which are reviewed here. The clinical signs of iatrogenic disease are usually nonspecific and identical to those resulting from other causes of surface disease. Factitious disease is either the result of mechanical trauma or the abuse of toxic eye drops. One epidemiological study, in a tertiary setting, identified 13% of keratoconjunctivitis cases as iatrogenic. Healing was prolonged taking 7-93 (median 28.5) days. Pathogenic mechanisms vary widely with different drugs and include subclinical scarring, pseudopemphigoid, drug-induced ocular cicatricial pemphigoid, and toxic follicular reactions. There is little readily available data either on the probability of the development of adverse reactions or for the comparison of different drugs. The assessment of the toxicity of topical drugs is currently by the Draize test in rabbits. New in vitro tests on human corneal epithelial cell cultures include ATP assays for cell viability, scanning EM of epithelial microvilli, and vital staining to assess cell membrane permeability and intracellular esterase. Despite their simplicity, these test systems can correlate well with clinical toxicity and provide a toxicity index for drug comparisons. Treatment requires drug withdrawal or substitution by nonpreserved and less toxic preparations. Factitious injury is rare, difficult to diagnose, and should only be considered when all other diagnoses have been excluded. Prevention requires a high level of awareness of the potential for iatrogenic disease, particularly in the high-risk setting of chronic ocular surface disease.

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“…142 Many drugs influence tear flow'43 and are contained in tears, thus becoming a factor in the wearing of contact lenses. The secretions of the lacrimal gland are controlled primarily by parasympathetic nerve fibers traveling in the seventh cranial nerve.…”

Section: Drug Effects On Tearsmentioning

confidence: 99%

Tear Analysis in Contact Lens Wearers

Rl¹

1986

Eye & Contact Lens: Science & Clinical Practice

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INTRODUCTION TEARS PLAY AN EXTREMELY IMPORTANT ROLE IN THE WEAR OF CONTACr LENSES.Improved techniques of tear analysis offer the possibility of discovering the solutions to problems arising from contact lens wear. At present, the increasing incidence of acute red eye and the deposits that develop on many extended-wear contact lenses are matters of particular concern. The purpose of this thesis is to review the results of analyses of human tears, with particular emphasis on studies of changes in the tears of contact lens wearers, and to report the results of present studies of human tear analysis in contact lens wearers. BACKGROUND TEAR FILM STRUCTUREWolff' suggested the precorneal tear film to be a three-layered structure consisting of a superficial oily layer, a middle aqueous layer, and a deep mucoid layer. In experiments by Mishima and M-aurice,2 occlusion of the meibomian glands of rabbits resulted in the disappearance of the superficial oily layer and an increase in the rate of evaporation from the cornea, which produced corneal thinning. These findings indicate that the oily film is secreted by the meibomian glands and serves to prevent evaporation from the tear film.The intermediate layer of the tear film, composed of aqueous tear fluid, is 6 ,u to 7.5 ,u thick. TEAR VOLUME AND FLOW Mishima et a19 used a fluorophotometer to determine the fluorescein concentration of human tears in situ. After fluorescein was instilled into the cul-de-sac, its concentration in the tears decreased quite rapidly for about 5 minutes and then more slowly. The initial turnover was interpreted as a result of reflex tear stimulation. The slower turnover rate, 16% per minute, was considered to indicate a physiologic turnover, representing a tear flow rate characteristic of normal, minimally stimulated tear secretions. By extrapolation of the lower decay curve to zero time and correction for the fast initial tear flow and greater tear volume, an average normal tear volume of 6.2 + 2.0 ,ul was obtained. Average tear flow was 1.2 ,u/minute, with a range of 0.5 to 2.2 RI/minute at the minimal stimulated baseline conditions. With subjects in an upright position, the maximum tear capacity of the cul-de-sac was estimated to be around 30 Pld; the rate of secretion that would cause overflow was estimated to be about 100 pul/minute in the presence of a normal drainage system. Tear flow easily increased 100% per minute or more when fluorescein solution was instilled. Jordan and Baum'0 recorded a 300% increase in turnover rate when the lid margin was stimulated gently with filter paper.When observed by slit lamp microscope, tears are seen to flow beneath a hard contact lens as it moves on the cornea during blinking. Fluorescein staining of the tears allows observation of the tear reservoir around the lens, which moves constantly in response to blinking and exchanges with the tear reservoir beneath the lens. Mishima"l described the change of the tear meniscus at the edge of the contact lens and measured fluorescein concentrations both under th...

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Adverse external ocular effects of topical ophthalmic medications

Cited by 167 publications

References 117 publications

Increasing Bacterial Resistance in Pediatric Acute Conjunctivitis (1997–1998)

Increasing Bacterial Resistance in Pediatric Acute Conjunctivitis (1997–1998)

Corneal toxicity: the epithelium and stroma in iatrogenic and factitious disease

Tear Analysis in Contact Lens Wearers

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