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Borzova E, Snarskaya E, Bratkovskaya A. Eyelid dermatitis in patch-tested adult patients: a systematic review with a meta-analysis. Sci Rep 2024; 14:18791. [PMID: 39138344 PMCID: PMC11322306 DOI: 10.1038/s41598-024-69612-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 08/07/2024] [Indexed: 08/15/2024] Open
Abstract
Eyelid dermatitis (ED) affects a cosmetically significant area and leads to patients' distress. Despite ongoing and recent research efforts, ED remains a multidisciplinary problem that needs further characterization. We aimed to evaluate the atopic eyelid dermatitis (AED) frequency in ED patients and to perform their clinical profiling. PubMed databases were searched from 01.01.1980 till 01.02.2024 to PRISMA guidelines using a search strategy: (eyelid OR periorbital OR periocular) AND (dermatitis or eczema). Studies with patch-tested ED patients were included. Proportional meta-analysis was performed using JBI SUMARI software. We included 65 studies across Europe, North America, Asia and Australia, with a total of 21,793 patch-tested ED patients. AED was reported in 27.5% (95% CI 0.177, 0.384) of patch-tested ED patients. Isolated ED was noted in 51.6% (95% CI 0.408, 0.623) of 8453 ED patients with reported lesion distribution, including 430 patients with isolated AED. Our meta-analysis demonstrated that the AED frequency in patch-tested ED patients exceeded the previous estimate of 10%. Isolated AED was noted in adult patients, attending contact allergy clinics. Future studies are needed to elucidate the global prevalence and natural history of isolated AED in adults.
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Affiliation(s)
- Elena Borzova
- Dermatology Division, Niigata University Graduate School of Medical and Dental Sciences (Medicine), 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan.
| | - Elena Snarskaya
- Department of Dermatology and Venereology, I.M. Sechenov First Moscow State Medical University, 4/1 Bolshaya Pirogovskaya Street, Moscow, Russian Federation, 119991
| | - Anna Bratkovskaya
- Department of Dermatology and Venereology, I.M. Sechenov First Moscow State Medical University, 4/1 Bolshaya Pirogovskaya Street, Moscow, Russian Federation, 119991
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Matei I, Beaulieu V, Ingen-Housz-Oro S, Assier H. Eyelid contact dermatitis occurring 2.5 years after continuous use of the same eye drops. Contact Dermatitis 2024; 91:75-76. [PMID: 38487930 DOI: 10.1111/cod.14547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/07/2024] [Accepted: 02/24/2024] [Indexed: 06/04/2024]
Affiliation(s)
- Ilaria Matei
- Department of Dermatology, AP-HP, Henri Mondor Hospital, Créteil, France
| | - Valérie Beaulieu
- Department of Dermatology, AP-HP, Henri Mondor Hospital, Créteil, France
- Department of Dermatology, Hôtel-Dieu de Québec, CHU de Québec - Université Laval, Québec, Canada
| | - Saskia Ingen-Housz-Oro
- Department of Dermatology, AP-HP, Henri Mondor Hospital, Créteil, France
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
| | - Haudrey Assier
- Department of Dermatology, AP-HP, Henri Mondor Hospital, Créteil, France
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
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3
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Ruiz-Lozano RE, Azar NS, Mousa HM, Quiroga-Garza ME, Komai S, Wheelock-Gutierrez L, Cartes C, Perez VL. Ocular surface disease: a known yet overlooked side effect of topical glaucoma therapy. FRONTIERS IN TOXICOLOGY 2023; 5:1067942. [PMID: 37547228 PMCID: PMC10403269 DOI: 10.3389/ftox.2023.1067942] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 07/14/2023] [Indexed: 08/08/2023] Open
Abstract
Ocular surface disease (OSD), a disorder affecting the lacrimal and meibomian glands and the corneal and conjunctival epithelium, is a well-known complication of topical glaucoma therapy. OSD can present as a new or pre-existing condition that virtually any anti-glaucoma formulation can exacerbate. As such, both glaucoma and OSD frequently coexist. Typical OSD symptoms include ocular discomfort, redness, burning, and dryness, whereas signs include periorbital and eyelid skin pigmentation, conjunctival scarring, and superficial punctate keratitis. Pressure-lowering eyedrops can cause toxic, allergic, and inflammatory reactions on the ocular surface. The latter can result from either preservatives or direct toxicity from the active molecule. Although usually mild, OSD can cause significant symptoms that lead to poor quality of life, decreased compliance to therapy, glaucoma progression, and worse visual outcomes. Given the chronic nature of glaucoma, lack of curative therapy, and subsequent lifelong treatment, addressing OSD is necessary. This manuscript aims to provide an up-to-date overview of OSD's signs, symptoms, and pathogenic mechanisms from glaucoma therapy toxicity.
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Affiliation(s)
- Raul E. Ruiz-Lozano
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de La Salud, Monterrey, Mexico
| | - Nadim S. Azar
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, NC, United States
| | - Hazem M. Mousa
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, NC, United States
| | - Manuel E. Quiroga-Garza
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, NC, United States
| | - Seitaro Komai
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, NC, United States
| | | | - Cristian Cartes
- Unidad Oftalmología, Departamento de Especialidades, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
| | - Victor L. Perez
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, NC, United States
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Ringuet J, Lajoie C, Bourgault S, Simonyan D, Houle MC. The Benefit Of Scratch Patch Testing To Demonstrate Ocular Contact Allergy To Brimonidine Tartrate. Contact Dermatitis 2022; 87:336-342. [PMID: 35642327 DOI: 10.1111/cod.14168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Ocular allergies to brimonidine are frequent in patients treated for glaucoma. There is variability in reporting due to the lack of diagnostic criteria and absence of cutaneous testing. Many false negative patch tests (PT) have been described. Alternative methods, such as strip and scratch PT, have been used without a standardized method. OBJECTIVES The primary objective is to identify the best method of cutaneous testing and brimonidine concentration for patch testing. The secondary objective is to identify clinical signs and symptoms suggestive of ocular allergy. PATIENTS AND METHODS A retrospective review of patient files suspected of brimonidine ocular allergy was performed. Patch testing method, brimonidine concentration and clinical symptoms were reviewed. RESULTS Of the 36 patients identified, half tested positive to brimonidine for at least one of the testing methods. The scratch PT demonstrated 17 positive reactions (94% detection rate). 3 patients reacted with strip PT. No positive results were found with standard PT. The 5% brimonidine concentration demonstrated the highest sensitivity. Absence of eyelid pruritus was associated with negative testing. CONCLUSION In the investigation of ocular allergy to brimonidine, scratch PT proved to be an essential tool. Brimonidine 5% pet. appeared as the most sensitive concentration for scratch PT.
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Affiliation(s)
- Julien Ringuet
- University Laval, Faculty of Medicine, Department of Dermatology, Québec, Canada.,Centre de Recherche Dermatologique du Québec Métropolitain (CRDQ), Québec, Québec, Canada
| | - Caroline Lajoie
- Département d'ophtalmologie et d'oto-rhino-laryngologie-chirurgie cervico-faciale, Faculté de médecine, Université Laval, Québec, Québec, Canada.,Centre universitaire d'ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec, Québec, Québec, Canada
| | - Serge Bourgault
- Département d'ophtalmologie et d'oto-rhino-laryngologie-chirurgie cervico-faciale, Faculté de médecine, Université Laval, Québec, Québec, Canada.,Centre universitaire d'ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec, Québec, Québec, Canada
| | - David Simonyan
- Clinical and Evaluative Research Platform, Centre Hospitalier Universitaire de Québec Research Center, Québec, Canada
| | - Marie-Claude Houle
- Department of Medicine, Division of Dermatology, Hôtel-Dieu de Québec, Université Laval, Québec, Canada
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Patchinsky A, Petitpain N, Gillet P, Angioi-Duprez K, Schmutz JL, Bursztejn AC. Dermatological adverse effects of anti-glaucoma eye drops: a review. J Eur Acad Dermatol Venereol 2022; 36:661-670. [PMID: 35032359 DOI: 10.1111/jdv.17928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/18/2021] [Indexed: 11/28/2022]
Abstract
Many patients are treated for glaucoma. Like other drugs, anti-glaucoma eye drops may induce dermatological adverse effects. We aim to review the dermatological adverse effects secondary to the active agents in anti-glaucoma eye drops through a literature review. In January 2020, we queried PubMed using the following MeSH terms: glaucoma/drug therapy or glaucoma, open angle/drug therapy cross-referenced with parasympathomimetics/adverse effects or adrenergic agonists/adverse effects or carbonic anhydrase inhibitors/adverse effects or prostaglandins F, synthetic/adverse effects or adrenergic beta antagonists/adverse effects or ophthalmic solutions/adverse effects. The initial search identified 1128 studies, of which 49 were excluded for being in a foreign language, 15 for not involving eye drops, 968 for not focusing on adverse dermatological effects, and 11 for insufficient documentation or redundancy. After adding 38 linked studies, we finally analysed 123 studies. The ocular and periocular dermatological adverse effects of eye drops are contact dermatitis, hyperpigmentation, prostaglandin analogue periorbitopathy, mucous membrane pemphigoid, eyelash depigmentation, skin hypertrichosis, and rare cases of melanoma and skin depigmentation. The reported distant dermatological adverse effects are psoriasis, excessive sweating, lichen planus, alopecia, toxic epidermal necrolysis, erythema multiforme, erythroderma, subacute cutaneous lupus erythematosus, nail pigmentation and bullous pemphigoid. Most of the cutaneous adverse effects of anti-glaucoma eye drops are ocular and periocular and induced by prostaglandin analogues. Distant adverse effects are rare and sometimes questionable but should be kept in mind, especially mucous membrane pemphigoid, which could lead to blindness. The role of preservatives, such as benzalkonium chloride, should also be considered.
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Affiliation(s)
- Alexandra Patchinsky
- Service de Dermatologie, CHRU DE NANCY Brabois, Bâtiment des Spécialités Médicales, rue de Morvan, 54511, Vandœuvre lès Nancy, France
| | - Nadine Petitpain
- Service de Pharmacovigilance, Bâtiment de Biologie Médicale et de Biopathologie, CHRU DE NANCY Brabois, rue de Morvan, 54511, Vandœuvre lès Nancy, France
| | - Pierre Gillet
- Service de Pharmacovigilance, Bâtiment de Biologie Médicale et de Biopathologie, CHRU DE NANCY Brabois, rue de Morvan, 54511, Vandœuvre lès Nancy, France.,Université de Lorraine, CNRS, IMoPA, F-54000, Nancy, France
| | - Karine Angioi-Duprez
- Service d'Ophtalmologie, Hôpital d'Adultes, CHRU DE NANCY Brabois, rue du Morvan, 54511, Vandœuvre lès Nancy, France
| | - Jean Luc Schmutz
- Service de Dermatologie, CHRU DE NANCY Brabois, Bâtiment des Spécialités Médicales, rue de Morvan, 54511, Vandœuvre lès Nancy, France
| | - Anne Claire Bursztejn
- Service de Dermatologie, CHRU DE NANCY Brabois, Bâtiment des Spécialités Médicales, rue de Morvan, 54511, Vandœuvre lès Nancy, France
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Risk factors for periorbital dermatitis in patients using dorzolamide/timolol eye drops. Sci Rep 2021; 11:17896. [PMID: 34504268 PMCID: PMC8429663 DOI: 10.1038/s41598-021-97565-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/19/2021] [Indexed: 01/22/2023] Open
Abstract
This study assessed the clinical risk factors for periorbital dermatitis (PD) after using dorzolamide/timolol eye drops in a total of 1282 glaucoma patients. Both the PD(+) group and the PD(−) group were evaluated using clinical data such as age, sex, dosing duration, presence of benzalkonium chloride (BAK) in the formulation, ocular surgery history (e.g. cataract or glaucoma operations), height, weight, personal history of systemic hypertension, smoking, alcohol consumption, intraocular pressure, best-corrected visual acuity (BCVA), central corneal thickness, axial length, and visual field index (VFI). Univariate analyses showed that shorter dosing duration, higher rate of BAK-included cases, worse BCVA, worse VFI, more systemic hypertension history, and more ocular surgery history were more associated with the PD(+) group than the PD(−) group. The BAK(−) group showed a lower PD rate than the BAK-included group, which was supported by the Kaplan–Meier analysis (log-rank test, p = 0.0014). Multivariate analyses revealed that the probability of PD increased by 8 times if they had a history of ocular surgery and increased by 2.3% when the VFI decreased by 1% (Cox’s hazard regression test, p < 0.001). Therefore, a preservative-free dorzolamide/timolol can benefit the subjects for those who had ocular surgery or who have worse VFI.
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Saito H, Kagami S, Mishima K, Mataki N, Fukushima A, Araie M. Long-term Side Effects Including Blepharitis Leading to Discontinuation of Ripasudil. J Glaucoma 2020; 28:289-293. [PMID: 30720574 DOI: 10.1097/ijg.0000000000001203] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PRECIS Blepharitis was the most common side effect leading to discontinuation of ripasudil therapy. Prior allergic reactions to other topical glaucoma were found to be a risk factor for ripasudil-induced blepharitis. PURPOSE To report the incidence proportion of blepharitis and its relating factors due to long-term use of 0.4% riapasudil, a Rho-kinase inhibitor, in glaucoma patients of a clinical setting. PATIENTS AND METHODS One hundred three eyes of 103 consecutive glaucoma patients who started ripasudil treatment between December 2014 and February 2017 at our institute, and who had a follow-up period of over 6 months were enrolled in this study. Incidence proportion, time required for recovery and risk factors associated with blepharitis and other side effects that led to discontinuation of ripasudil treatment were considered. RESULTS The most frequently observed side effect was blepharitis (25.2%). The 12- and 24-month discontinuation rate due to blepharitis was 21.1%±8.2% and 34.6%±11.8% (average±SE), respectively (Kaplan-Meier analysis). Most patients recovered from blepharitis symptoms within 4 weeks, but 5 patients required over 8 weeks for recovery. Past history of allergic reactions to other topical glaucoma medication was significantly correlated with the manifestation of blepharitis (Cox proportional hazard model, P<0.007) while age, sex, intraocular pressure reduction rate, number of administered eye drops, history of systemic allergic diseases were not. CONCLUSIONS Blepharitis was the most common reason for discontinuation of ripasudil treatment. Although most cases were resolved spontaneously, prolonged blepharitis was observed in a few patients. A past history of allergic reaction to other glaucoma medication indicates a higher possibility of blepharitis with ripasudil use and warrants careful administration.
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Affiliation(s)
| | - Shinji Kagami
- Dermatology, Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Tokyo
| | | | | | - Atsuki Fukushima
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi, Japan
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Nayak B, Gupta S, Kumar G, Dada T, Gupta V, Sihota R. Socioeconomics of long-term glaucoma therapy in India. Indian J Ophthalmol 2016; 63:20-4. [PMID: 25686057 PMCID: PMC4363951 DOI: 10.4103/0301-4738.151458] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To determine the socioeconomic impact of long-term glaucoma therapy. MATERIALS AND METHODS One hundred and fifty consecutive glaucoma patients on medical therapy, following up at our glaucoma service for at least 6 months were recruited. A questionnaire regarding monthly income, cost of glaucoma medications prescribed, availability of medications, travel time, time spent in review clinics, compliance, education status, medical insurance and systemic or local side-effects was administered. RESULTS The patients seen at the tertiary government hospital had an average monthly income of Rs. 10,912/- (range: Rs. 500/- to Rs. 50,000/-) with approximately 56% of the patients having an income of less than Rs. 5000/month. The expenditure on anti-glaucoma medications ranged from 0.3% in high income group to 123% of their monthly gross income in low income group (P < 0.0001). The total expenditure including travel, stay, and loss of wages of patients and accompanying persons ranged from 1.6% in high income group to 137% of the monthly income in low income group (P < 0.0001). Mean time required for a glaucoma clinic visit was 15.66 h, (range: 6-96 h/month). About 2.7% experienced systemic side-effects and 21.3% had complaints of ocular adverse effects. About 90% of the patients were compliant. 92% were not covered by any insurance plan/government reimbursement for their treatment. CONCLUSIONS Medical therapy for glaucoma is an economic burden to many patients and should be individualized, according to the socioeconomic status, availability of drugs and the required distance to travel to reach the specialist clinics.
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Affiliation(s)
- Bhagabat Nayak
- Glaucoma Research Facility and Clinical Services, All India Institute of Medical Sciences, New Delhi, India
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9
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Allergic Contact Dermatitis to Ophthalmic Medications: Relevant Allergens and Alternative Testing Methods. Dermatitis 2016; 27:333-347. [DOI: 10.1097/der.0000000000000224] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Abstract
The side effects of topical dorzolamide hydrochloride, such as conjunctivitis, eyelid edema, and eye lid irritation, are well known. However, allergic contact dermatitis due to dorzolamide is rare, although the product has been commonly used worldwide in patients with glaucoma. To the best of our knowledge, this is the first report of allergic contact dermatitis caused by topical dorzolamide hydrochloride in Korea. Herein we report a case of allergic contact dermatitis due to topical dorzolamide eyedrops.
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Affiliation(s)
- Seung-Jun Lee
- Department of Ophthalmology, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Moosang Kim
- Department of Ophthalmology, School of Medicine, Kangwon National University, Chuncheon, Korea
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11
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12
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Bagnis A, Papadia M, Scotto R, Traverso CE. Antiglaucoma drugs: The role of preservative-free formulations. Saudi J Ophthalmol 2011; 25:389-94. [PMID: 23960953 DOI: 10.1016/j.sjopt.2011.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Revised: 08/18/2011] [Accepted: 08/24/2011] [Indexed: 11/18/2022] Open
Abstract
Hypersensitive reactions to eyedrops are a common finding in clinical practice and represent a frequent cause of discontinuation of the therapy. Moreover, experimental and clinical studies show that long term use of topical drugs may induce ocular surface changes causing discomfort and potentially negatively affecting the compliance to the treatment as well as the success rate of filtering procedures. The exact mechanism involved and the roles of the active compound and the preservatives in inducing such detrimental effects of ophthalmic solutions are unclear. During the last years several antiglaucoma agents have been marketed as either preservative-free or benzalkonium chloride-free formulations in an attempt to reduce the adverse effects related to preservatives. This paper summarizes the body of evidence from existing studies about preservatives in antiglaucoma eyedrops, focusing on the latest compounds commercially available. A systematic review of the literature was performed. Current research is focusing not only on the efficacy of the drugs but also on their tolerability. Based on the existing data, there is a rationale to support the use of benzalkonium-free solutions whenever possible, especially in patients suffering from concomitant ocular surface diseases, experiencing local side effects and in those expected to need multiple and prolonged topical treatments.
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Affiliation(s)
- Alessandro Bagnis
- Eye Clinic, Department of Neurosciences, Ophthalmology and Genetics, University of Genova, Genova, Italy
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13
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Servat JJ, Bernardino CR. Effects of common topical antiglaucoma medications on the ocular surface, eyelids and periorbital tissue. Drugs Aging 2011; 28:267-82. [PMID: 21428462 DOI: 10.2165/11588830-000000000-00000] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Glaucoma affects millions of people around the world. With the baby boom generation aging, the number of people affected by primary open-angle glaucoma in the US is expected to reach 3.3 million by 2020, and about half may not know they have the disease. The treatment of most forms of glaucoma includes the use of topical agents that enhance aqueous humour outflow, reduce aqueous production, or both. Topical intraocular pressure-lowering drugs must penetrate across the tissues of the eye to reach their therapeutic targets. Often, these tissues show the first signs and symptoms of drug toxicity and adverse effects. These include eyelid dermatitis, malpositions, lacrimal system scarring, ocular discomfort upon instillation, tear film instability, conjunctival inflammation, subconjunctival fibrosis, conjunctival epithelium changes, and corneal surface and endothelial impairment. For these reasons, ophthalmologists should evaluate the risks and benefits of ophthalmic medications before initiating therapy, identify the minimum dosages necessary to achieve a therapeutic benefit, and monitor patients for local and systemic adverse effects. Adverse events may be reduced by changing to a different class of topical medication, using corticosteroids, lubricating the eyes frequently, and reducing exposure to preservatives. This in turn can lead to higher levels of adherence to antiglaucoma therapy, improved outcomes and a reduction in the costs associated with long-term glaucoma complications. This article reviews the ocular adverse effects associated with the various classes of topical antiglaucoma drugs, with a particular focus on the ocular surface, eyelids and periorbital tissue.
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Affiliation(s)
- J Javier Servat
- William Beaumont Eye InstituteConsultants in Ophthalmic and Facial Plastic Surgery, Royal Oak, Michigan, USA.
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14
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Abstract
Skin toxicity is the most important side effect of cetuximab administration, but little is known about the eye toxicity, including periorbital skin. We present here four cases of patients with metastatic colorectal carcinoma treated with the combination of cetuximab, irinotecan, 5-fluorouracil and leucovorin who had manifestation of complications in the eye or periorbital skin. These manifestations consisted of erythematous eruptions in the periorbital skin with blepharitis and conjunctivitis in three patients and trichomegaly in one patient. The symptoms were controlled with local therapy including corticosteroids and antibiotics. The skin toxicity in the periorbital region is more important than in other skin areas because of the impact on the social activity of the patient and the vision. The manifestations of eye toxicity of cetuximab may be controlled by local therapy, and the management of these patients requires the collaboration of medical oncologist and ophthalmologist.
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Affiliation(s)
- B Melichar
- Department of Medicine, Charles University Medical School and Teaching Hospital, Hradec Králové, Czech Republic.
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15
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Kluger N, Guillot B, Raison-Peyron N. Systemic contact dermatitis to dorzolamide eye drops. Contact Dermatitis 2008; 58:167-8. [DOI: 10.1111/j.1600-0536.2007.01143.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Hegde V, Robinson R, Dean F, Mulvihill HA, Ahluwalia H. Drug-Induced Ectropion. Ophthalmology 2007; 114:362-6. [PMID: 17270684 DOI: 10.1016/j.ophtha.2006.09.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2004] [Revised: 09/22/2006] [Accepted: 09/23/2006] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To review cases of possible drug-induced ectropion and recommend what we consider to be best practice. DESIGN Retrospective observational case series. PARTICIPANTS Thirteen consecutive outpatients. METHODS Records of 13 outpatients on topical medication presenting with topical drug-induced ectropion were retrospectively analyzed. MAIN OUTCOME MEASURES Eyelid position, topical agent causing the allergy, and medical and surgical management options. RESULTS In all 13 patients, the ectropion resolved partially or completely after discontinuing the offending topical agent. Dorzolamide (53%) was the most common offending agent, followed by brimonidine (23%). One of the 13 patients underwent failed ectropion surgery correction before referral, but improved once the topical agent was discontinued. Two of the patients successfully underwent surgical correction for ectropion after discontinuing their topical therapy. Those patients who discontinued the topical therapy and had a short course of steroid therapy did not require surgical correction. CONCLUSIONS This study demonstrates that sensitivity to topical agents can induce ectropion in more than 1 manner. Chronic exposure to the causative agent leads to cicatricial changes in the anterior lamella of the eyelid in susceptible individuals, and can manifest as contact dermatitis leading to tissue edema and mechanical ectropion. Early recognition of this condition and discontinuation of therapy is of paramount importance; it may lead to complete resolution. Topical steroids are a necessary adjunct in the management of drug-induced ectropion. Based on our experience, we propose a management algorithm for drug-induced ectropion.
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Affiliation(s)
- Vijay Hegde
- Princess Alexandra Eye Pavilion, Edinburgh, United Kingdom.
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17
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Bhatt R, Whittaker KW, Appaswamy S, Desai A, Fitt A, Sandramouli S. Prospective survey of adverse reactions to topical antiglaucoma medications in a hospital population. Eye (Lond) 2004; 19:392-5. [PMID: 15297863 DOI: 10.1038/sj.eye.6701515] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
AIM To identify the relative incidence and profile of adverse drug reaction (ADR) to various topical ocular hypotensives in a hospital setting. METHODS All the patients presenting in outpatients clinic and accident and emergency with an ADR to topical hypotensive agent from August 2000 to January 2001 were included in the study. Details regarding the type date of commencing the treatment, the date of developing ADR, time to resolution of the ADR were noted. RESULTS Over the period of 6 months, 66 patients presented with 73 ADRs. Brimonidine was the most frequent offending agent. In total, 23 (34.8%) presented with ADR after being commenced on treatment for more than 12 months. In all, 16 (24%) patients had IOP > 21 on presentation, eight (12%) patients underwent filtration surgery following the development of ADR. CONCLUSION Adverse drug reaction to ocular hypotensive agents is not uncommon and can have a major impact on glaucoma management. Delayed presentation and association with raised intraocular pressure presentation emphasise the need for effective patient education to encourage prompt reporting of ADR.
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Affiliation(s)
- R Bhatt
- Wolverhampton & Midland Counties Eye Infirmary, Wolverhampton WV3 9QR, UK
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Mullins RJ, Lones R, Dutta B. Lichenoid drug eruption secondary to topical timolol and dorzolamide eye-drops. Australas J Dermatol 2004; 45:151-2. [PMID: 15068470 DOI: 10.1111/j.1440-0960.2004.00074.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Davani S, Delbosc B, Royer B, Kantelip JP. Choroidal detachment induced by dorzolamide 20 years after cataract surgery. Br J Ophthalmol 2002; 86:1457-8. [PMID: 12446402 PMCID: PMC1771393 DOI: 10.1136/bjo.86.12.1457] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- S Davani
- Pharmacovigilance Centre, Besançon, France.
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Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2002; 11:621-36. [PMID: 12462142 DOI: 10.1002/pds.663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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