Cyclopentolate in treatment of sarin miosis

Moylan-Jones, R. J.; Thomas, D. Price

doi:10.1111/j.1476-5381.1973.tb06917.x

Cited by 20 publications

(3 citation statements)

References 5 publications

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“…Absorption from the nasal mucosa after transiting the nasolacrimal duct was demonstrated in this study by Kaila et al, 11 but volume limitations of the canthal space resulted in a delay in reaching T max . The use of dilating eye drops in the outpatient setting for sustained miosis has been described in a human trial; 6 healthy volunteers exposed to sarin vapor (0.5 mg/m 3 for 30 min) received 60 ul of 1% cyclopentolate intraocular 18 . The authors did not note improvement in visual acuity, refraction, or pupil diameter, but concluded that full dark adaptation (preservation of night vision – a military consideration) or distressing ocular symptoms (pain) might be indications.…”

Section: Resultsmentioning

confidence: 99%

“…Pharmaceutical Alternatives for Nerve Agents Disaster Medicine and Public Health Preparedness sarin vapor (0.5 mg/m 3 for 30 min) received 60 ul of 1% cyclopentolate intraocular. 18 The authors did not note improvement in visual acuity, refraction, or pupil diameter, but concluded that full dark adaptation (preservation of night visiona military consideration) or distressing ocular symptoms (pain) might be indications. In a real-world incident, miosis refractory to systemic antimuscarinic therapy is a significant impairment after nerve agent exposure, and mydriatic eye drops are effective therapy.…”

Section: Options For Antimuscarinic Drugs Ophthalmic Atropine Solutiomentioning

confidence: 99%

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Contingency Medical Countermeasures for Mass Nerve-Agent Exposure: Use of Pharmaceutical Alternatives to Community Stockpiled Antidotes

Schwartz

Sutter

Eisnor

et al. 2018

Disaster med. public health prep.

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Having sufficient medical countermeasures (MCMs) available for the treatment of acetylcholinesterase-inhibiting nerve agent poisoned patients following a mass chemical exposure is a challenge for communities. After stockpiles containing auto-injectors are exhausted, communities need to be aware of alternative pharmaceutical options. The Department of Homeland Security Chemical Defense Program convened a federal interagency working group consisting of first responders, clinicians, and experts from the fields of medical toxicology, pharmacology, and emergency management. A literature review of pharmaceutical alternatives for treating nerve agent toxicity was performed. Pharmaceuticals that met the federal Public Health Emergency Medical Countermeasures Enterprise Product Specific Requirements were prioritized. Food and Drug Administration approval for one indication, market availability, and alignment to government procurement strategy were considered. This article summarizes the literature on comparative pharmacokinetics and efficacy against nerve agents (where available) of Food and Drug Administration approved drugs with muscarinic acetylcholine receptor antagonist and gamma-aminobutyric acid receptor agonist effects. This work is intended to serve as a resource of pharmaceutical options that may be available to communities (ie, emergency managers, planners, clinicians, and poison centers) when faced with a mass human exposure to a nerve agent and inadequate supplies of MCMs. (Disaster Med Public Health Preparedness. 2019;13:605-612)

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Section: Resultsmentioning

confidence: 99%

Section: Options For Antimuscarinic Drugs Ophthalmic Atropine Solutiomentioning

confidence: 99%

Contingency Medical Countermeasures for Mass Nerve-Agent Exposure: Use of Pharmaceutical Alternatives to Community Stockpiled Antidotes

Schwartz

Sutter

Eisnor

et al. 2018

Disaster med. public health prep.

View full text Add to dashboard Cite

show abstract

“…Very mild casualties suffering from sarin-induced ocular insult only, may benefit from topical (Ohbu et al, 1997;Okudera, 2002) rather than systemic anticholinegic treatment (Ohbu et al, 1997;Yanagisawa et al, 2006) since the later may induce systemic side effects (Hurst et al, 2007) with no ocular benefit. Short acting anticholinergic topical eye drops, such as tropicamide, are preferable to the more potent and longer lasting eye drops such as atropine, homatropine or cyclopentolate, which may induce long-term mydriasis and cycloplegia and may even worsen visual acuity and performance (Geoghegan and Tong, 2006;Moylan-Jones and Thomas, 1973;Nozaki and Aikawa, 1995a;Gore et al, 2012;Holstege et al, 1997;Sidell and Borak, 1992). In casualties with additional symptoms such as lacrimation, increased salivation, rhinorrhea, tightness in the chest, sweating, nausea, vomiting, and abdominal cramps (considered mild casualties), systemic treatment of atropine and oximes intramuscular (im) should be used with the addition of topical treatment if ocular symptoms are present (Holstege et al, 1997;Sidell, 1997;Weissman and Raveh, 2011).…”

Section: Abbreviationsmentioning

confidence: 99%

Synergism Between Anticholinergic and Oxime Treatments Against Sarin-Induced Ocular Insult in Rats

et al. 2015

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Eye exposure to the extremely toxic organophosphorus sarin results in long-term miosis and visual impairment. As current treatment using atropine or homatropine eye drops may lead to considerable visual side effects, alternative combined treatments of intramuscular (im) oximes (16.8 µmol/kg, im) with atropine (0.5 mg/kg, im) or with the short acting antimuscarinic tropicamide (0.5%; w/v) eye drops were thus evaluated. The combined treatments efficacy following topical exposure to sarin (1 µg) was assessed by measuring pupil width and light reflex using an infra-red based digital photographic system. Results showed that the combined treatment of various oximes with atropine or with topical tropicamide eye drops rapidly reversed the sarin-induced miosis and presented a long-term improvement of 67-98% (oxime+tropicamide) or 84-109% (oxime+atropine) in pupil widening as early as 10-min following treatment. This recovery was shown to persist for at least 8-h following exposure. All combined treatments facilitated the ability of the iris to contract following sarin insult as tested by a light reflex response.Our findings emphasize the high efficacy of im oxime treatment combined with either atropine im or tropicamide eye drops in counteracting sarin-induced ocular insult. Therefore, in a mass casualty scenario the systemic combined treatment may be sufficient to ameliorate sarin-induced ocular insult with no need for additional, topical anticholinergic treatment at least in the initial stage of intoxication. For very mild casualties, who are unlikely to receive im treatment, the combined oxime (im) with topical tropicamide treatment may be sufficient in ameliorating the ocular insult.

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Ophthalmic Toxicology

Ballantyne¹

2009

General, Applied and Systems Toxicology

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Ophthalmic toxicology is a specialist area that deals with potentially adverse effects on the eye from chemicals and their metabolites, reaching the eye by local contact and from the systemic circulation, and also covers the effects that may be produced systemically by chemicals that have been absorbed into the circulation following topical contact with the eye. This chapter reviews, with illustrative examples, all these aspects of ophthalmic toxicology, with particular reference to causation, mechanisms of production of lesions, relevant in vivo and in vitro laboratory testing procedures, the significance and clinical relevance of the observed effects. Site‐specific lesions and functional disturbances in the eye that are discussed in detail are those to the cornea, iris, ciliary body, aqueous humour production, the lens, retina, optic nerve and extraocular muscles. Systemic effects following topical contamination of the eye are discussed particularly for chemicals and drugs, and discussed in terms of the sites of absorption.

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Cyclopentolate in treatment of sarin miosis

Cited by 20 publications

References 5 publications

Contingency Medical Countermeasures for Mass Nerve-Agent Exposure: Use of Pharmaceutical Alternatives to Community Stockpiled Antidotes

Contingency Medical Countermeasures for Mass Nerve-Agent Exposure: Use of Pharmaceutical Alternatives to Community Stockpiled Antidotes

Synergism Between Anticholinergic and Oxime Treatments Against Sarin-Induced Ocular Insult in Rats

Ophthalmic Toxicology

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