Deepening of lid sulcus from topical bimatoprost therapy

PURPOSE

To report a new adverse effect related to treatment with bimatoprost.

CASE REPORTS

Serial clinical examination of three patients was performed. In each of the three reported patients, alteration of eyelid appearance with deepening of the lid sulcus was evident as the result of topical bimatoprost therapy.

DISCUSSION

A comprehensive literature search of Medline using WebMd and MDConsult, was conducted to cross reference known side effects of topical prostaglandin analog treatment. The keywords utilized were prostaglandin analogs, prostaglandins, prostamide, glaucoma, ocular hypertension, intraocular pressure, side effects, adverse effects, bimatoprost, latanoprost, lumigan, and xalatan. This appears to be the first such report in the literature. Clinicians and patients should be made aware of this possible complication of topical bimatoprost therapy.

Apraxia of lid opening: dose-dependent response to carbidopa-levodopa

A 67-year-old woman with an 8-year history of Parkinson's disease and Lewy body dementia experienced difficulty in opening her eyelids (apraxia of lid opening [ALO]); she could close them without difficulty. This problem emerged 2 weeks after the patient's dosage of carbidopa 50 mg-levodopa 200 mg 3 times/day was decreased to twice/day. Two weeks after the onset of ALO the patient visited her physician, who suspected carbidopa-levodopa of causing the problem; the drug was discontinued. When the patient's condition worsened rather than improved, she was referred to a neuro-ophthalmologist, who confirmed the diagnosis of ALO. However, the neuro-ophthalmologist noted that this may not have been a true apraxia but rather a form of sustained blepharospasm that prevented the eyelid from opening. Carbidopa-levodopa was restarted, and her condition improved dramatically when her dosage was increased gradually to carbidopa 50 mg-levodopa 200 mg in the morning and at noon, and carbidopa 25 mg-levodopa 100 mg in the evening. Clinicians should be aware of adverse reactions, such as AOL, in patients taking carbidopa-levodopa who have dementia of the Lewy body type.

[Periorbital swelling caused by carbasalate calcium]

A 61-year-old man presented with visual problems due to a marked two-sided periorbital swelling that had started three years earlier. There was no obvious underlying cause and he had persistent rhinoconjunctival symptoms. At the time the swelling started he was already suffering from xanthelasmata palpebrarum and chronic obstructive pulmonary disease. He had been taking simvastatin and salmeterol-fluticason for a year and carbasalate calcium for two years. There was marked periorbital swelling accompanied by xanthelasmata palpebrarum and slight chemosis and erythema of the eyelids. After exclusion of other potential causes for the swelling, acenocoumarol was prescribed in place of carbasalate calcium. This resulted in a quick recovery from the swelling and rhinoconjunctival symptoms. Provocation with acetyl salicylic acid led to renewed swelling of both eyelids. Periorbital angio-oedema, a relatively uncommonly reported side effect of acetyl salicylic acid and its derivates, can occur even after previous long-term medication use.

Demographic and Clinical Factors Associated with Development of Brimonidine Tartrate 0.2%-Induced Ocular Allergy

PURPOSE

To identify demographic and clinical characteristics associated with the development of brimonidine tartrate 0.2%-induced ocular allergy.

PATIENTS AND METHODS

In this retrospective study, 133 patients affected by primary open-angle, pigmentary, narrow angle, or pseudo-exfoliative glaucoma and treated with brimonidine tartrate 0.2% were divided into two groups: allergic and non allergic to brimonidine tartrate 0.2%. The distribution of demographic (age and sex), local (history of allergic conjunctivitis, previous eye-drop ocular allergy, use of other concurrent topical medications, amount of topical medications previously used, use of contact lenses, and tear film production), and systemic (history of systemic allergies and use of systemic drugs) factors was evaluated by comparing the brimonidine tartrate 0.2% allergic and the non-allergic groups.

RESULTS

In this study, 13.5% of patients (18 of 133) developed brimonidine ocular allergy generally within two weeks from the beginning of treatment (mean time 14.8 +/- 17.9 days). The brimonidine tartrate 0.2% allergic group showed a significantly higher frequency of history of ocular allergy to eye-drops (P = 0.048) and to topical beta-blockers (P = 0.019) when compared with the brimonidine tartrate 0.2% non-allergic group. Moreover, the allergic group showed a decreased tear film production (P = 0.044).

CONCLUSION

This study showed that history of eye-drop allergies and reduction of tear film production were more frequently associated with the development of brimonidine tartrate 0.2%-induced ocular allergy.

A double application approach to ophthalmia neonatorum prophylaxis

AIMS

To investigate if a second drop of 2.5% povidone-iodine ophthalmic solution placed within the first postnatal day would achieve better prophylaxis against ophthalmia neonatorum than a single drop applied at birth.

METHODS

A masked, prospective, controlled trial was conducted over a 2 year period in a Kenyan hospital. Randomisation was achieved by alternating weeks of one or two eye drop application to both eyes. All 719 neonates received one drop of the povidone-iodine solution to both eyes at birth, while 317 received a second drop at hospital discharge or 24 (SD 4) hours after delivery, whichever was first. All infants developing conjunctivitis within a month after birth underwent microbiological analysis using Gram and Giemsa stains, direct fluorescent antibody assay for Chlamydia trachomatis, and culture.

RESULTS

Of the neonates receiving the one eye drop application, 18.4% returned with a red eye with discharge, 4.0% had organisms found on the initial smear, and 8.2% had a positive culture. The corresponding proportions for the multidrop group were 24.3%, 4.7%, and 10.4%. Of those returning with an inflamed eye, there were no cases of Neisseria gonorrhoeae, 4.2% in the single dose group and 3.9% in the double dose group were positive for C trachomatis, and 5.4% and 6.5% respectively for Staphylococcus aureus. At discharge, the eyelid oedema score of the double dose group was mildly greater than the single dose group (1.4 (0.67) v 1.2 (0.73), p=0.0002). There was no statistically significant difference between the groups in any other category.

CONCLUSION

There is no advantage to administering povidone-iodine prophylaxis against ophthalmia neonatorum twice in the first postnatal day over a single application at birth.

Œdème palpébral secondaire au traitement par inhibiteur de la tyrosine kinase : Glivec®

Iatrogenic causes for palpebral edema are rarely suspected and must be specifically sought. The authors report a case of palpebral edema in a patient treated with a specific inhibitor of the BCR-ABL tyrosine kinase (Glivec) for chronic myeloid leukemia. Histopathological analysis of specimens of the excised upper eyelid tissue revealed the absence of leukemic infiltration, suggesting the toxic effect of the treatment. This side effect should be noted so that patients are informed and biopsy is proposed to eliminate tumoral infiltration.

Ocular surface, ocular adnexal, and lacrimal complications associated with the use of systemic 5-fluorouracil

PURPOSE

To determine the prevalence rates and associated characteristics of patients who have ocular surface, ocular adnexal, and lacrimal complications associated with the systemic use of the cancer chemotherapeutic agent 5-Fluorouracil (5-FU).

METHODS

An exposure-based cohort study was designed. Adult patients who had completed at least 3 months of systemic 5-FU therapy within the past 5 years were eligible for enrollment. Study subjects had a detailed medical history taken with emphasis on preexisting conditions known to be associated with the development of ocular surface, ocular adnexal, and lacrimal complications. An ocular examination was then performed. A complete nasolacrimal system evaluation was performed if symptoms or findings were identified. The prevalence was then determined for each ocular symptom and each ocular finding identified that was not present pretreatment. An exploratory analysis was then performed to identify patient characteristics that might influence the likelihood of developing any of the above complications.

RESULTS

Fifty-two patients were enrolled in the study. The prevalence rates of the following ocular abnormalities were calculated: ocular irritation, 5.8%; blepharitis, 3.8%; conjunctivitis, 3.8%; keratitis, 3.8%; eyelid dermatitis, 5.8%; cicatricial ectropion, 1.9%; tearing, 26.9%; punctal-canalicular stenosis, 5.8%; and blurred vision, 11.5%. Blacks had tearing at a significantly higher rate when compared with whites (P = 0.022, 2-sided Fisher exact test). Three patients had permanent complications that will require surgery for correction. Of the 7 patients who had a single abnormality, 6 had tearing and one had eyelid dermatitis. All of the 8 patients who had multiple findings had tearing as one of their abnormalities.

CONCLUSIONS

Ninety-three percent of the patients who had an ocular abnormality had tearing as one of the complications. Patients who are receiving systemic 5-FU and begin to tear should have an ocular examination, looking for ocular surface, ocular adnexal, and lacrimal complications.

Festoon formation after infraorbital botulinum A toxin: a case report

BACKGROUND

An injection of the lateral canthus and infraorbital fold is commonly used to soften wrinkles and widen the eye.

OBJECTIVE

To illustrate a case report of festooning and to hypothesize as to its cause.

METHODS

A 56-year-old man developed festooning of the infraocular area after injection of botulinum toxin A.

RESULTS

Prior lower lid blepharoplasty with separation of the infraorbital orbicularis oculi muscle may have weakened the muscle enough to cause festooning with further weakening of the muscle through botulinum toxin A injection.

CONCLUSION

Caution must be exercised when performing infraocular injection of botulinum toxin A in patients with prior transtarsal lower lid blepharoplasty.

Increased periocular pigmentation with ocular hypotensive lipid use in African Americans

PURPOSE

To report increased eyelid pigmentation as an adverse side effect associated with topical ocular hypotensive lipids in African Americans.

DESIGN

Interventional case series.

METHODS

Two African-American patients with open-angle glaucoma are described in whom increased eyelid pigmentation developed 1 month to 5 months after beginning treatment with either latanoprost or bimatoprost.

RESULTS

Latanoprost was discontinued in an African-American patient, and pigmentation gradually diminished by 3 months after cessation of latanoprost. Increased eyelid pigmentation and increased eyelash length were noted in another African-American patient after just 4 weeks on bimatoprost.

CONCLUSIONS

An increase in eyelid pigmentation and eyelash growth is a possible complication of topical ocular hypotensive lipid therapy, even in African-American patients. The changes seems to present earlier after bimatoprost treatment then after latanoprost treatment. Cessation of these medications may lead to loss of induced pigmentation.

[Allergic contact eczema from shellac and 1,3-butylene glycol in an eyeliner]

BACKGROUND

The diagnostic approach to eyelid eczema is often a great problem in daily practice.

PATIENT AND METHOD

A 16-year old girl developed recurrent severe pruritic edema of the eyelids, followed by redness and scaling. Various cosmetics particularly an eyeliner were considered as possible causes. Patch testing was performed with the standard series, some supplemental series and all ingredients of the eyeliner.

RESULTS

The eyeliner produced a papular reaction after 2 days of open application, confirming a high degree of contact sensitization. The patient reacted with a 3+ reaction to the ingredients shellac (20% in ethanol) and 1,3-butylene glycol (2% in water). All remaining materials failed to produce a reaction.

CONCLUSIONS

Careful allergologic investigations are necessary in cases of edema and/or eczema of the eyelids; the cosmetics used by the patients are of utmost importance. The causative allergen may not be present in the usual patch test series and can only be identified by testing all ingredients. Shellac is now widely used in cosmetics and is increasingly identified as a contact allergen in eye make up.

[Side-effects and risk profile of latanoprost 0.005% (Xalatan)]

BACKGROUND

Latanoprost, a prostaglandin F(2alpha)-analogue, has been widely in use in clinical practice for a period of over 5 years. The side-effects of latanoprost are analyzed and the clinical relevance is discussed.

RESULTS

Hypertrichosis and increased pigmentation of eyelashes will develop in the majority of patients using latanoprost for more than 6 months. Increased pigmentation of the eyelids may also occur. Hyperpigmentation of the iris is seen in 12-18% of caucasians using latanoprost over a period of 1-2 years. Increased iris pigmentation seems more common in asian people and remains unchanged after discontinuation of therapy. Pigmentation of intra- and extraocular structures is caused by increased melanogenesis, not by melanocyte proliferation. Mild conjunctival hyperemia may develop in approximately 30% of patients, but is most often without clinical relevance. Further reported side-effects include anterior uveitis, reactivation of herpes-keratitis/-dermatitis and cystoid macular edema in pseudophakic and aphakic patients. A causal relationship has still not been proven for these side-effects. Systemic side-effects are rare (e.g. headache, facial rash, cardiovascular effects). No experience exists for treatment of glaucoma with latanoprost in childhood.

CONCLUSION

Latanoprost represents a highly effective antiglaucomatous drug, rarely associated with vision-threatening complications. The most common complications are hypertrichosis of eyelashes and increased pigmentation of extra- and intraocular structures. A careful lifetime evaluation of these patients is recommended. Systemic side-effects are rare, but may occur.

Multiple bilateral eyelid molluscum contagiosum lesions associated with TNFalpha-antibody and methotrexate therapy

PURPOSE

To demonstrate a patient developing multiple bilateral eyelid molluscum contagiosum lesions after initiation of TNFalpha-antibody therapy for rheumatoid arthritis.

DESIGN

Single interventional case report.

METHODS

Clinical, histopathologic, and immunologic-serological findings are presented.

RESULTS

A 67-year-old patient with a 5-year history of rheumatoid arthritis had been treated with prednisone and methotrexate for the last 5 years. After initiation of additional TNFalpha-antibody treatment, complaints from rheumatoid arthritis subsided, but multiple bilateral molluscum contagiosum lesions of upper and lower eyelids occurred despite normal or only slightly reduced CD(4) (420-178/ microl) and CD(8) counts (143-58/microl). Histopathologic evaluation of the excised warts confirmed the clinical diagnosis. Under continued therapy, the warts have been recurring for 12 months.

CONCLUSION

TNFalpha-antibody treatment for rheumatoid arthritis may compromise the host response to molluscum contagiosum, especially if methotrexate is given additionally. Patients should be informed about this potential complication.

Meige syndrome with apraxia of lid opening after the discontinuation of sulpiride treatment

We report a case of Meige syndrome with apraxia of lid opening that lasted for about seven months after discontinuation of sulpiride treatment. To our knowledge, this is the first report demonstrating that Meige syndrome with apraxia of lid opening is induced by sulpiride, and that the condition persists.

Lower eyelid herniation of orbital fat may complicate periocular corticosteroid injection

PURPOSE

To report a case of lower eyelid herniation of orbital fat occurring after periocular corticosteroid injection.

DESIGN

Interventional case report.

METHODS

A 44-year-old man with asymmetrical pars planitis complicated by right cystoid macular edema was treated with multiple right orbital floor injections of triamcinolone through the lower eyelid.

RESULTS

Right lower eyelid orbital fat herniation occurred during the course of the treatment.

CONCLUSION

A herniation of orbital fat may complicate the injection of corticosteroid through the lower eyelid.