Allergic contact dermatitis from phenylephrine in eyedrops

Phenylephrine is widely used as an ophthalmic drug. However, there are only very few reports on allergic contact dermatitis induced by phenylephrine. In addition, little is known on cross reactivity patterns between the sympathomimetics phenylephrine, epinephrine and ephedrine which share a similar chemical structure. We report on a man who developed allergic contact dermatitis to Neosynerphin POS eyedrops containing phenylephrine hydrochloride. Cross reactivity between phenylephrine, epinephrine and ephedrine was studied by patch testing. Patch tests were performed with the European standard, an ophthalmics and preservatives series, Neosynerphin POS eyedrops, phenylephrine hydrochloride 10% aq., epinephrine and ephedrine (both 1.0 % aq.). Test sites were read after 48, 72 and 168 hours according to the recommendations of the ICDRG. Neosynerphin POS and phenylephrine hydrochloride 10 % aq. gave positive reactions, whereas epinephrine and ephedrine tested negative. Although phenylephrine is an epinephrine analog delayed type hypersensitivity to phenylephrine did not result in cross reactivity with chemically related epinephrine and ephedrine.

Eyelid hypertrichosis associated with latanoprost is reversible

A 56-year-old woman with primary open-angle glaucoma in an only eye presented with hypertrichosis after using Latanoprost to lower IOP. After trabeculectomy with adjunctive Mitomycin C, IOP was well controlled and antiglaucoma medications could be discontinued. At eight-month follow-up the abnormal eyelashes had disappeared.

Evaluation of long-term sedation in cheetah (Acinonyx jubatus) with perphenazine enanthate and zuclopenthixol acetate

Two long-acting neuroleptics were used to tranquilize nine captive cheetahs (Acinonyx jubatus). Perphenazine enanthate (3.0 mg/kg) and zuclopenthixol acetate (0.6 mg/kg) were each administered to separate groups of three cheetahs in a double blind trial. Both products were administered together to a third group of three animals at the same dosages. Behavioral effect, duration of effect, and possible side effects were observed by a predefined protocol. Under standardized holding conditions, the cheetahs were observed 5 days before drug administration and 14 days after administration. Daily activity was defined and statistically evaluated by a U-test. A significant reduction of activity was observed after administration in all three trials. Zuclopenthixol acetate at 0.6 mg/kg alone and in combination with perphenazine enanthate caused inappetence, ataxia, extra pyramidal reactions, akathisia, and prolapse of the third eyelid. Zuclopenthixol acetate should not be used in cheetahs. Perphenazine enanthate did not cause inappetence, reduced appetite, or any of the previously mentioned side effects when used alone. It produced satisfactory tranquilization and is suitable and safe for cheetahs at 3.0 mg/kg. This dosage should be varied depending on health, age, and temperament of the individual cheetah.

Acute and subchronic neurotoxicological evaluation of tetrahydrofuran by inhalation in rats

Groups of adult male and female rats received exposure to tetrahydrofuran (THF) vapor by inhalation in acute or subchronic exposure scenarios. Acute exposure concentrations were 0, 500, 2500, or 5000 ppm for 6 hr. Evaluations conducted immediately after exposure included clinical observations, motor activity assessments (MA), and a battery of functional tests (FOB) designed to reveal nervous system dysfunction. During exposure to 2500 and 5000 ppm, rats had a diminished or absent startle response to a punctate auditory alerting stimulus. Following exposure to 5000 ppm, male and female rats were lethargic, exhibited abnormal gait or mobility, and splayed rear feet. Lethargy and splayed rear feet were also observed in females exposed to 2500 ppm. During the subsequent FOB, males exposed to 5000 ppm had a lower incidence of palpebral closure, higher incidences of slow or absent righting reflex, and a biphasic pattern of reduced motor activity followed by increased motor activity. Females exposed to 5000 ppm had increased incidences of palpebral closure in the open field, increased incidences of slow or absent righting reflex, and decreased motor activity. During the 14-week subchronic exposure series, daily THF exposure concentrations were 0, 500, 1500, or 3000 ppm, and neurobehavioral evaluations occurred on non-exposure days at approximately monthly intervals. Diminished startle responses to an auditory alerting stimulus were observed during exposure to 1500 or 3000 ppm; however, repeated exposures did not cause additional neurobehavioral or pathological effects. This pattern of effects is suggestive of transient sedation. Despite daily reinstatement of acute sedative effects during repeated exposure with up to 3000 ppm, THF did not produce any persistent or cumulative effects on nervous system structure or function. The demonstrated no-observed-effect level of THF for both acute and subchronic exposure was 500 ppm.

Sirolimus-associated eyelid edema in kidney transplant recipients

BACKGROUND

The immunosuppressant sirolimus is effective in preventing acute rejection episodes. So far, unusual edema formation has not been reported as a side effect.

METHODS

Two groups of patients with renal transplants, consisting of 11 patients each, were followed for up to 29 months. The immunosuppressive regimen was either sirolimus and prednisone with or without cyclosporine or azathioprine/mycophenolate and prednisone with cyclosporine. Routine follow-up included a thorough clinical investigation. Edema formation was documented photographically.

RESULTS

In 5 of the 11 patients treated with sirolimus uni- or bilateral, non-itching, eyelid edema was observed. After discontinuation of sirolimus, lid edema disappeared. The duration until recovery varied from weeks to months. No cause of edema formation other than the treatment with sirolimus was detected.

CONCLUSIONS

Severe eyelid edema formation seems to be associated with sirolimus treatment. The underlying mechanism is unknown.

[Long-term results after therapy of paraffin induced sclerosing lipogranuloma of the eyelids and the anterior orbit in three patients]

BACKGROUND

Chronic lipogranuloma of anterior orbit and the eyelids is a rare inflammatory pseudotumor with a high tendency of recurrence. It is most commonly related to prior endonasal sinus surgery.

HISTORY AND SIGNS

We report on three patients with chronic lipogranulomata who were treated at the university eye-hospital of Düsseldorf during the last 8 years. These cases are discussed individually and longterm results are presented.

THERAPY AND OUTCOME

Three patients underwent endonasal surgery with postsurgical use of paraffin nasal packing prior to the occurrence of chronic lipogranulomata. Histologic findings uniformly revealed granulomatous processes but in none was there any sign of a systemic granulomatous disorder (such as Boeck's disease). Additionally, one of these three patients suffered from neuroophthalmologic impairment due to infiltration of oculomotore structures. Early surgical treatment if only for extended biopsy did result in immediate severe recurrence of the disease. No recurrence of the disease has been observed, however, if surgery was duely postponed.

CONCLUSIONS

Lipogranulomata seem to be caused by postsurgical paraffin nasal packing. Early treatment seems to be unfavourable because of the high tendency of recurrence. Surgical removal of any tumor masses should be delayed therefore till granuloma formation has presumably come to an end. Any early surgery should be limited to a diagnostic biopsy if judged necessary.

Increased eyelid pigmentation associated with use of latanoprost

PURPOSE

To report increased eyelid pigmentation as an adverse side effect associated with topical latanoprost.

METHOD

Case report. A 62-year-old Korean woman with normal-tension glaucoma developed bilateral increased eyelid skin pigmentation 4 months after beginning treatment with latanoprost in both eyes. Clinical examinations were performed, and external photographs were taken.

RESULT

Latanoprost was discontinued. Periodic examinations revealed that the eyelid skin pigmentation gradually diminished 1 month after the cessation of the drug, and decrease in pigmentation continued over 4 months of follow-up.

CONCLUSION

An increase in eyelid skin pigmentation is a possible complication of topical latanoprost therapy, and the cessation of the drug can result in loss of induced pigmentation in humans.

Delayed-hypersensitivity granulomatous reaction induced by blepharopigmentation with aluminum-silicate

Blepharopigmentation has been introduced during the last decade as a technique for creating a permanent line along the eyelid margin, thus simulating a cosmetic eyeliner. Complications related to this procedure are mostly reported in the opthalmologic literature describing infectious, allergic, or technical problems. We report a case of a woman who underwent blepharopigmentation with aluminum-silicate and in whom a delayed hypersensitivity granulomatous reaction developed.

Histopathological study of frontalis suspension materials

PURPOSE

This study is designed to find the most suitable frontalis suspension material by comparing the histopathologic findings of frequently used suspension materials in vivo.

METHODS

Three kinds of suspension materials-autologous fascia lata, 1-0 Prolene suture material, and Silicone Band-were implanted in the white rabbit. Histopathologic study was done sequentially 1 week, 2 weeks, 4 weeks, and 8 weeks after implantation.

RESULTS

Histologically, autologous fascia lata showed less inflammatory reaction and better incorporation with surrounding structures than the Silicone Band and suture material. Suture material and Silicone Band showed marked inflammatory reaction and did not incorporate or tightly bond with surrounding tissue in any of the samples.

CONCLUSIONS

Fresh autologous fascia lata appears to be the most suitable material for frontalis suspension after histopathological testing.

[Lyell's syndrome and its ophthalmologic manifestations in Cameroon]

BACKGROUND

To study basic epidemiological datas and ocular involvment during toxic epidermal necrolysis (T.E.N.) in Cameroonian patients.

METHODS

Ten consecutive patients in the Central Hospital of Yaounde were included during a 4 years period. Anamnesis, clinical features, dermatological, ophthalmological and pathological examinations were done. Minimal follow up of 3 months.

RESULTS

Mean age: 20.1 +/- 11.4 yrs (SD); culprit drugs: sulfadoxin (5/10), sulfamethoxazol (3/10); phenytoin (1/10). Mean of skin detachment: 41 +/- 17%. 2 patients died with sulfadoxin as culprit drug. Early ocular findings: conjunctivitis (all patients), symblepharon (1/8), ankyloblepharon (3 patients over 8 with sulfadoxin as culprit drug). All cases with ankyloblepharon (3) evoluated toward formation of a fibrovascular precorneal membrane with blindness. Two of the patients received a kerothoprosthesis on one eye. The 3 patients had a severe dry eye syndrome.

CONCLUSION

TEN appears to be uncommon in Cameroon. Use of sulfonamides for treatment and prevention of malaria and AID'S opportunistic infections may increase the incidence of disease in tropical african areas. Ophthalmologists should be aware of early management of ocular manifestations in Lyell syndrome to avoid severe sequelae. That sequelae may be due to usual intensive healing in African patients. Severe corneal damages can be corrected only by keratoprosthesis.

Extensive lower eyelid pigment spread after blepharopigmentation

PURPOSE

To report on a complication of blepharopigmentation.

METHODS

Case report.

RESULTS

An 81-year-old woman underwent cosmetic tattooing of all four eyelids. The pigment immediately spread from the right lower eyelid lash line to the nasojugal fold. The dispersion was so extensive in surface area that nonsurgical techniques for ameliorating the dispersion would not be effective. The unintentionally tattooed skin was excised and reconstructed with a lateral canthal suspension and full thickness skin grafts. Pathologic examination of the excised tissue revealed pigmentation of all layers of the skin and the surface of the orbicularis muscle.

CONCLUSION

This case illustrates that extensive pigment spread following blepharopigmentation may require extensive reconstruction to correct the problem.

"Apraxia of eyelid opening" induced by levodopa therapy and apomorphine in atypical parkinsonism (possible progressive supranuclear palsy): a case report

We report a female patient in whom so-called apraxia of eyelid opening (AEO) developed after the onset of possible progressive supranuclear palsy (National Institute of Neurological Disorders and Stroke criteria) and the introduction of antiparkinsonian medications including levodopa. Although parkinsonian symptoms responded poorly to levodopa, AEO worsened after increasing levodopa dosage and disappeared when levodopa was discontinued. Later, a dose of apomorphine widely accepted for acute tests had no significant effect on limb motor activity but induced AEO. Overall, these observations are grounds for thinking that AEO developing in the course of parkinsonism may be either disease- or drug-related. The possibility of manipulating dopaminergic treatment should always be considered when dealing with AEO associated with parkinsonism.

Eyelid pruritus with intravenous morphine

The cause of eyelid pruritus (itching) may be difficult to determine, particularly in preverbal children. Tearing, photophobia, or eye rubbing may be the first manifestation of leukemic infiltration or graft-versus-host disease, necessitating early appropriate therapy. We report a child in whom persistent eye rubbing developed after bone marrow transplantation for leukemia. Morphine administration was found to be the cause of this symptom.