The local vasoconstriction of infant’s skin following instillation of mydriatic eye drops

Abstract

The risks of percutaneous toxicity must always be considered in children, especially in premature neonates, in whom the epidermal permeability barrier is frequently incompetent. Application of smaller drop size or wiping of overflowed drop from the skin may be useful to decrease the risk of systemic side effects.

Palidez peri orbitaria post aplicación de midriaticos en neonatos con hidrocefalia asociado a efectos sistémicos

“…The vasoconstriction periorbital has been reported previously, mainly in relation to the characteristics of the skin of the premature neonate, which are the most susceptible population 3 . However in this report, one of the reported cases is a term neonate, who in theory presents a lower risk, for he possess a less immature skin.…”

“…It is clear that the group of infants, especially premature infants due to cutaneous characteristics, are the population at greatest risk for local and systemic complications, but we believe that there must be other associated factors in this population. This is due to the cases of Alpay et al 3 , who reported a similar event of vasoconstriction in a term neonate, which was not associated with hydrocephalus, but also did not clarify which factor could trigger it.…”

“…It is estimated that over 90% of a topical ophthalmic may be a dose potentially available to act systemically 4 , however, it is proposed that self palpebral closure age, minimizing flicker and performing a compression of the lacrimal sac for 1 to 2 minutes after application of the drops, thus occluding the lacrimal duct, prevents the passage of the drug by this route and increased systemic absorption. It is clear that these techniques are, apparently, not that frequent to prevent the systemic absorption and there is no generalization of these, for it could imply a risk of injury in preterm infants 3 , thus it is rarely applied.…”

“…Periorbital vasoconstriction, related to skin absorption of phenylephrine, has been reported secondary to skin immaturity, characteristic of prematurity 3 . Phenylephrine is not a selective drug on ocular structures.…”

Use of Physostigmine for Cyclopentolate Overdose in an Infant

“…Systemic absorption of these drugs occurs primarily via nasal mucosa and conjunctiva, nasolacrimal duct, oropharynx, digestive system, and skin. 2,3 The toxicity is dose-related. 2 Early recognition of systemic toxicity after eye drop instillation is important.…”