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Abstract
Epidermal growth factor receptor (EGFR) inhibitors have become an important therapy for patients with malignant solid tumors, such as non-small cell lung, breast, ovarian, colorectal, renal, esophageal, sarcoma, mesothelioma, prostate, head and neck, and pancreatic cancers. Although these agents are generally well tolerated, some adverse effects will likely occur. The most common adverse effect associated with use of EGFR inhibitors is an acne-like rash. Less reported in the literature are adverse ocular reactions, which occur in approximately one third of patients and can cause significant discomfort. The ocular toxicities that may occur with use of EGFR inhibitors can be broadly categorized as changes in the eyelids (eg, squamous blepharitis, trichomegaly, meibomitis), changes in the tear film (eg, dysfunctional tear syndrome), and miscellaneous changes (eg, iridocyclitis, corneal epithelial defect). Early recognition and management of these adverse ocular reactions are necessary to improve patient comfort, to facilitate compliance, and to avoid interruption of therapy. This article describes the adverse ocular effects reported to occur with use of EGFR inhibitors and presents specific strategies to manage these effects. Mild eyelid and tear film changes usually can be managed by the oncology and nursing staff. More severe ocular reactions require involvement of an ophthalmologist.
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Weng PW, Hsu HM, Chen TW, Hsieh CB, Chang TM, Chen VTK, Yu JC. Blue angioedema of eyelip after patent blue injection for lymphatic mapping procedure. Eur J Cancer Care (Engl) 2007; 16:390-1. [PMID: 17587366 DOI: 10.1111/j.1365-2354.2007.00807.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sentinel node biopsy using patent blue dye in breast cancer is a well-documented procedure to assess the axillary status. We presented an unusual and previously unreported complication of simple blue angioedema over bilaterally periorbital tissue after blue dye injection.
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Gupta S, Silliman CG, Trump DL. Docetaxel-induced Meibomian duct inflammation and blockage leading to chalazion formation. Prostate Cancer Prostatic Dis 2007; 10:396-7. [PMID: 17404582 DOI: 10.1038/sj.pcan.4500939] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We report a 71-year male with castration-resistant metastatic prostate cancer who was treated with weekly docetaxel for 12 weeks and developed significant eye irritation and dryness during treatment. Subsequently, the patient presented with a lower eyelid mass, which on excision was demonstrated to be a chalazion. Docetaxel induced Meibomian duct inflammation and blockage is the likely cause of this presentation in a patient with no history of eyelid masses in the past.
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Hrubec TC, Yan M, Ye K, Salafia CM, Holladay SD. Valproic acid-induced fetal malformations are reduced by maternal immune stimulation with granulocyte-macrophage colony-stimulating factor or interferon-gamma. ACTA ACUST UNITED AC 2007; 288:1303-9. [PMID: 17075842 PMCID: PMC2567843 DOI: 10.1002/ar.a.20397] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Valproic acid, a drug commonly used to treat seizures and other psychiatric disorders, causes neural tube defects (NTDs) in exposed fetuses at a rate 20 times higher than in the general population. Failure of the neural tube to close during development results in exencephaly or anencephaly, as well as spina bifida. In mice, nonspecific activation of the maternal immune system can reduce fetal abnormalities caused by diverse etiologies, including diabetes-induced NTDs. We hypothesized that nonspecific activation of the maternal immune system with interferon-gamma (IFN-gamma) and granulocyte-macrophage colony-stimulating factor (GM-CSF) could reduce valproic acid (VA)-induced defects as well. Female CD-1 mice were given immune stimulant prebreeding: either IFN-gamma or GM-CSF. Approximately half of the control and immune-stimulated pregnant females were then exposed to 500 mg/kg VA on the morning of gestational day 8. The incidence of developmental defects was determined on gestational day 17 from at least eight litters in each of the following treatment groups: control, VA only, IFN-gamma only, IFN-gamma+VA, GM-CSF only, and GM-CSF+VA. The incidence of NTDs was 18% in fetuses exposed to VA alone, compared to 3.7% and 2.9% in fetuses exposed to IFN-gamma+VA, or GM-CSF+VA respectively. Ocular defects were also significantly reduced from 28.0% in VA exposed groups to 9.8% in IFN-gamma+VA and 12.5% in GM-CSF+VA groups. The mechanisms by which maternal immune stimulation prevents birth defects remain unclear, but may involve maternal or fetal production of cytokines or growth factors which protect the fetus from the dysregulatory effects of teratogens.
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Roy FH. Itchy eyelids. ANNALS OF OPHTHALMOLOGY (SKOKIE, ILL.) 2007; 39:183-184. [PMID: 18025622 DOI: 10.1007/s12009-007-0019-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2007] [Revised: 11/30/1999] [Accepted: 03/27/2007] [Indexed: 05/25/2023]
Abstract
Itchy eyelids is a symptom. This article outlines the steps for the practitioner to identify the cause of the itching and institute medical treatment.
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Centofanti M, Oddone F, Chimenti S, Tanga L, Citarella L, Manni G. Prevention of dermatologic side effects of bimatoprost 0.03% topical therapy. Am J Ophthalmol 2006; 142:1059-60. [PMID: 17157592 DOI: 10.1016/j.ajo.2006.07.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2006] [Revised: 06/27/2006] [Accepted: 07/04/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE To investigate the efficacy of reducing the drop-skin contact to prevent dermatologic side effects of bimatoprost 0.03% topical therapy. DESIGN Prospective, randomized, single-blinded, internally controlled study. METHODS Enrolled subjects started bimatoprost 0.03% therapy once at night in both eyes and were instructed to wipe selectively only one eye (eye 1) with an adsorbent pad during and after drops administration for four months. The fellow eye acted as the internal control. Eyelash growth, regional skin hypertrichosis, and pigmentation on the periocular skin were assessed at baseline and during the four months of follow-up. RESULTS A lower incidence of eyelash growth and skin pigmentation in the inferonasal pericanthal region were observed in eye 1. The incidence of pigmentation in the inferotemporal skin region and skin hypertrichosis were similar in the two eyes. CONCLUSION The reduction of the drop-skin contact affects the regional incidence and the extent of dermatologic skin changes that are related to bimatoprost 0.03% topical therapy.
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Kurata T, Tamura K, Okamoto I, Satoh T, Nakagawa K, Fukuoka M. Pemetrexed-induced edema of the eyelid. Lung Cancer 2006; 54:241-2. [PMID: 16996165 DOI: 10.1016/j.lungcan.2006.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Revised: 08/08/2006] [Accepted: 08/14/2006] [Indexed: 10/24/2022]
Abstract
Pemetrexed is a novel antimetabolite that targets multiple enzymes in the folate pathway, and has exhibited clear antitumor activities in the treatment of malignant pleural mesothelioma and non-small cell lung cancer. Although many adverse events of pemetrexed, such as bone marrow suppression, have been reported, edema of the eyelid has been previously reported in only one case (0.2%, n=519), according to the Pemetrexed Clinical Investigator's Brochure, April 2005 version. We experienced a patient who developed the valuable edema of the eyelid. We believe that medical oncologists should be aware of this rare adverse event, although the mechanism responsible for it is not yet known.
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Hayasaka Y, Hayasaka S, Matsukura H. Ocular findings in Japanese children with nephrotic syndrome receiving prolonged corticosteroid therapy. Ophthalmologica 2006; 220:181-5. [PMID: 16679793 DOI: 10.1159/000091762] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2005] [Accepted: 11/25/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine ocular findings in Japanese children with nephrotic syndrome who receive prolonged corticosteroid treatment. METHODS Information was retrospectively obtained from each patient's record. RESULTS A total of 45 children (30 boys and 15 girls) were enrolled. Twenty-one patients (46.7%) had epiblepharon with inverted eyelashes. The incidence of epiblepharon was associated with overweight and obesity. Fifteen patients (33.3%) developed posterior subcapsular cataract in both eyes. Of the 15 patients, 4 had visual acuity less than 0.4 and underwent cataract extraction in both eyes. Nine patients (20%) developed intraocular pressure higher than 22 mm Hg during corticosteroid treatment. The total dose and duration of corticosteroid treatment were associated with cataract formation but were unassociated with elevated intraocular pressure. One boy had elevated intraocular pressure after cessation of corticosteroid therapy and underwent trabeculectomy. One patient had repeated hordeolum in the left eyelid. Three patients had bilateral bacterial conjunctivitis. CONCLUSION Children with nephrotic syndrome who receive corticosteroid treatment may have epiblepharon, cataract, ocular hypertension, hordeolum and bacterial conjunctivitis.
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Rodríguez NA, Abarzuza R, Cristóbal JA, Sierra J, Mínguez E, Del Buey MA. [Eyelid contact allergic eczema caused by topical ketorolac tromethamine 0.5%]. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2006; 81:213-6. [PMID: 16688645 DOI: 10.4321/s0365-66912006000400007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
CLINICAL CASE A 65-year-old man had been treated with eye-drops containing NSAIDs (Ketorolac). He developed conjunctival injection, edematous swelling of the eyelids and periorbital dermatitis due to a contact allergy. Allergy to NSAIDs is uncommon. DISCUSSION This is an unusual case because topical application of ketorolac is safe in the vast majority of ophthalmologic patients. However adverse events associated with Ketorolac are similar to that of other NSAIDs.
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Modschiedler K, von den Driesch P, Paus R. [Hyperpigmentosis and hypertrichosis of the eyelids after use of bimatoprost eye drops]. J Dtsch Dermatol Ges 2005; 3:276-7. [PMID: 16370476 DOI: 10.1111/j.1610-0387.2005.05705.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
After application of bimatoprost containing eye drops for four weeks, a 72 year-old patient, suffering from glaucoma, developed hyperpigmentation and hypertrichosis of the eyelids. These symptoms can be seen in 1-10% of the patients as side effects in local therapy with bimatoprost, a prostaglandin analogue. The changes persist for varying periods of time but are reversible. Although prostaglandin analogues are sometimes more effective in the reduction of the intraocular pressure than beta-adrenoreceptor blocking agents, they remain second-line choices because of their side effects. This case report is meant to re-stimulate interest in the as yet obscure role of prostaglandins in hair biology, in clarifying the underlying mechanisms, and in exploring the possible therapeutic use of prostaglandin analogues in the management of hair loss (e.g. in androgenetic alopecia) or hair depigmentation (e.g. poliosis, canities).
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Gathse A, Ibara JR. [Reasons for consulting related to skin-bleaching products used by 104 women in Brazzaville]. BULLETIN DE LA SOCIETE DE PATHOLOGIE EXOTIQUE (1990) 2005; 98:387-9. [PMID: 16425720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
A prospective survey has been carried out in the Brazzaville (Congo) dermatology service in order to specify dermatosis linked to the use of bleaching agents in 104 Congolese women consulting for this problem. The used bleaching agents were topical corticoids based products for 40 cases, hydroquinone for 32 cases, and hydroquinone associated with topical dermocorticoids for 32 cases. Acne was the most frequent motive for consulting (24%), followed by the paradoxical peri-orbital hyperpigmentation (21.1%), profuse mycosis (16.3%) and vibices(8.6%). The results of this survey were not superimposable to those of Dakar where infectious dermatosis were the first reason for consulting.
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Donker DLT, Paridaens D, Mooy CM, van den Bosch WA. Blepharoptosis and upper eyelid swelling due to lipogranulomatous inflammation caused by silicone oil. Am J Ophthalmol 2005; 140:934-6. [PMID: 16310482 DOI: 10.1016/j.ajo.2005.05.028] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2005] [Revised: 05/11/2005] [Accepted: 05/11/2005] [Indexed: 11/19/2022]
Abstract
PURPOSE Report of two patients who presented with unilateral upper eyelid swelling and ptosis 1 and 8 years, respectively, after vitreoretinal surgery with intraocular silicone oil. DESIGN Report of two cases. METHODS In the first case, the oil was still present in the eye. In the second case, the intraocular oil and an epibulbar buckle had been removed 7 years earlier. RESULTS Histopathology of upper eyelid skin and preaponeurotic fat revealed lipogranulomatous inflammation. CONCLUSIONS Leakage of intraocular silicone oil into the eyelid tissues may cause an inflammatory reaction resulting in eyelid swelling and ptosis. We presume that in the first patient, silicone oil had leaked from the eye during or after surgery; in the second patient, silicone oil had probably been left behind in the space previously occupied by the epibulbar buckle.
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Galloway GD, Eke T, Broadway DC. Periocular Cutaneous Pigmentary Changes Associated With Bimatoprost Use. ACTA ACUST UNITED AC 2005; 123:1609-10. [PMID: 16286629 DOI: 10.1001/archopht.123.11.1609] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Kapur R, Osmanovic S, Toyran S, Edward DP. Bimatoprost-Induced Periocular Skin Hyperpigmentation. ACTA ACUST UNITED AC 2005; 123:1541-6. [PMID: 16286616 DOI: 10.1001/archopht.123.11.1541] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To investigate light microscopic and ultrastructural changes in bimatoprost-induced skin hyperpigmentation. METHODS Eyelid biopsy specimens from bimatoprost-treated patients and matched controls were examined by light microscopy and transmission electron microscopy. Using an image analyzer, melanin granules were counted on Fontana-Masson-stained sections, and melanosomes were counted on electron micrographs. Immunohistochemical analysis was performed with antibodies against S100 and CD3. Positively labeled cells were counted. RESULTS By light microscopy, a marked increase in the number of melanin granules was noted in the bimatoprost-treated specimens. Electron microscopy demonstrated dermal melanocytes with prominent rough endoplasmic reticulum and abundant normal-sized melanosomes in different stages of maturation as compared with control specimens. Furthermore, the keratinocytes of the bimatoprost-treated specimens showed abundant mature melanosomes when compared with controls. Also of note, atypical melanocytes were absent in both specimens. The S100-positive melanocytes were comparable in bimatoprost-treated and control specimens. Few CD3- and CD68-positive cells in the bimatoprost-treated specimens were noted in both groups. CONCLUSION Bimatoprost-induced periocular hyperpigmentation is caused by increased melanogenesis. There was no evidence of melanocyte proliferation or prostaglandin-induced inflammation in the specimens that were examined.
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Abstract
PURPOSE : Botulinum neurotoxins are considered relatively safe therapy for treatment of inappropriate muscle spasms. As seen in this report, undesirable consequences may result. METHODS : The author conducted a clinical interview and examination of the patient. RESULTS : Unilateral left-sided madarosis and facial alopecia were observed in a patient undergoing botulinum A toxin injections for the treatment of left oromandibular dystonia. The patient had started treatment 18 months previously. He received injections every 3 months in the left masseter and left temporalis muscles. He first noted loss of his left sideburn 8 months into treatment. After 10 months of treatment, he noted that he no longer needed to shave on the left side of his face. Eighteen months after receiving his first botulinum toxin injection, madarosis of the temporal aspect of the left lower lid was observed. CONCLUSIONS : This is the first case report documenting an idiosyncratic unilateral madarosis and facial alopecia as adverse side effects presumed secondary to botulinum A toxin injections.
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Merkur AB, Jardeleza MSR, Iliff NT, Iliff WJ, Miller NR, Green WR. Periocular petrolatum. Ophthalmic Plast Reconstr Surg 2005; 21:23-31. [PMID: 15677949 DOI: 10.1097/01.iop.0000150413.31785.36] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This report describes the clinical and histopathologic features and discusses the diagnostic difficulties and management of periocular deposition of petrolatum-based materials. METHODS Excision of orbital and eyelid tissue, tissue processing, and histopathologic examination was performed in patients with deposition of petroleum-based products. Transmission electron microscopy was performed in 3 cases. RESULTS Between 1983 and 2003, 11 patients were diagnosed with periocular petrolatum deposition, based on clinical history and the characteristic histopathologic features of polymorphic dropout spaces, and varied from a noninflammatory lesion (paraffinoma) to those with an associated granulomatous inflammatory reaction. CONCLUSIONS The diagnosis of petrolatum deposition can be challenging due to the range of symptoms and variable delay in presentation. Petrolatum products should be avoided during surgery and used judiciously in the postoperative period. To avoid confusion with nonspecific cases of lipogranulomatous inflammation, the terms "ointment granuloma" or "orbital paraffinoma" should be used to refer to patients presenting with orbital/eyelid lesions caused by ointment use.
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Dejobert Y, Delaporte E, Piette F, Thomas P. Eyelid dermatitis with positive patch test to coconut diethanolamide. Contact Dermatitis 2005; 52:173. [PMID: 15811046 DOI: 10.1111/j.0105-1873.2005.0548n.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
We report the case of a 51-year-old woman who had an immediate skin reaction after subcutaneous administration of a local anesthetic (LA) composed of articaine and epinephrine before a dental procedure. The patient subsequently underwent further dental procedures without LA. Skin prick tests performed with commercial LAs (lidocaine, mepivacaine, bupivacaine and articaine) were negative with epinephrine and all LAs except articaine. In 10 healthy controls, skin prick tests with articaine were negative. Subcutaneous challenge test with mepivacaine (0.3 and 0.5 ml) was negative. Provocations with the remaining anesthetics of the amide group were not carried out due to the patient's refusal.
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Guilabert A, Bosch X, Julià M, Iranzo P, Mascaró JM. Pegylated interferon alfa-induced sarcoidosis: two sides of the same coin. Br J Dermatol 2005; 152:377-9. [PMID: 15727663 DOI: 10.1111/j.1365-2133.2005.06326.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Corazza M, Masieri LT, Virgili A. Doubtful Value of Patch Testing for Suspected Contact Allergy to Ophthalmic Products. Acta Derm Venereol 2005; 85:70-1. [PMID: 15848998 DOI: 10.1080/00015550410024102] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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