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Menke BA, Ryu C, Justin GA, Chundury RV, Hayek BR, Debiec MR, Yeh S. Ophthalmic manifestations and management considerations for emerging chemical threats. FRONTIERS IN TOXICOLOGY 2023; 5:1281041. [PMID: 37941806 PMCID: PMC10629503 DOI: 10.3389/ftox.2023.1281041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/03/2023] [Indexed: 11/10/2023] Open
Abstract
Chemical agents have been utilized for centuries in warfare and pose a health threat to civilians and military personnel during armed conflict. Despite treaties and regulations against their use, chemical agent exposure remains a threat and measures to understand their effects and countermeasures for systemic and organ-specific health are needed. Many of these agents have ocular complications, both acute and chronic. This mini-review focuses on key chemical agents including vesicants (mustards, lewisite), nerve agents (sarin, VX), knockdown gasses (hydrogen cyanide), and caustics (hydrofluoric acid). Their ophthalmic manifestations and appropriate treatment are emphasized. Acute interventions include removal of the source and meticulous decontamination, as well as normalization of pH to 7.2-7.4 if alteration of the ocular pH is observed. Besides vigorous lavage, acute therapies may include topical corticosteroids and non-steroid anti-inflammatory therapies. Appropriate personal protective equipment (PPE) and strict donning and doffing protocols to avoid healthcare provider exposure are also paramount in the acute setting. For more severe disease, corneal transplantation, amniotic membrane graft, and limbal stem cell transplantation may be needed. Orbital surgery may be required in patients in whom cicatricial changes of the ocular surface have developed, leading to eyelid malposition. Multidisciplinary care teams are often required to handle the full spectrum of findings and consequences associated with emerging chemical threats.
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Affiliation(s)
- Bryant A. Menke
- Department of Ophthalmology, Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, United States
| | - Christine Ryu
- Department of Ophthalmology, Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, United States
| | - Grant A. Justin
- Walter Reed National Military Medical Center, Washington, DC, United States
| | - Rao V. Chundury
- Department of Ophthalmology, Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, United States
- National Strategic Research Institute, University of Nebraska Medical Center, Omaha, NE, United States
| | - Brent R. Hayek
- North Georgia Eye Clinic, Gainesville, GA, United States
| | - Matthew R. Debiec
- Walter Reed National Military Medical Center, Washington, DC, United States
| | - Steven Yeh
- Department of Ophthalmology, Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, United States
- National Strategic Research Institute, University of Nebraska Medical Center, Omaha, NE, United States
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE, United States
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Sanyal S, Ravula V. Mitigation of pesticide-mediated ocular toxicity via nanotechnology-based contact lenses: a review. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023:10.1007/s11356-023-28904-z. [PMID: 37542697 DOI: 10.1007/s11356-023-28904-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/17/2023] [Indexed: 08/07/2023]
Abstract
The xenobiotic stress exerted by pesticides leads to the deterioration of human and animal health including ocular health. Acute or prolonged exposure to these agricultural toxicants has been implicated in a number of pathological conditions of the eye such as irritation, epiphora or hyper-lacrimation, abrasions on the ocular surface, and decreased visual acuity. The issue is compounded by the fact that tissues of the eye absorb pesticides faster than other organs of the body and are more susceptible to damage as well. However, there is a lacuna in our knowledge regarding the ways by which pesticide exposure-mediated ocular insult might be counteracted. Topical instillation of drugs known to combat the pesticide induced toxicity has been explored to mitigate the detrimental impact of pesticide exposure. However, topical eye drop solutions exhibit very low bioavailability and limited drug residence duration in the tear film decreasing their efficacy. Contact lenses have been explored in this respect to increase bioavailability of ocular drugs, while nanoparticles have lately been utilized to increase drug bioavailability and increase drug residence duration in different tissues. The current review focuses on drug delivery and futuristic aspects of corneal protection from ocular toxicity using contact lenses.
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Affiliation(s)
- Shalini Sanyal
- Laboratory of Self Assembled Biomaterials and Translational Science, Institute for Stem Cell Science and Regenerative Medicine (DBT-inStem), GKVK Post, Bellary Road, Bengaluru, 560065, Karnataka, India.
| | - Venkatesh Ravula
- Laboratory of Self Assembled Biomaterials and Translational Science, Institute for Stem Cell Science and Regenerative Medicine (DBT-inStem), GKVK Post, Bellary Road, Bengaluru, 560065, Karnataka, India
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García Del Valle I, Alvarez-Lorenzo C. Atropine in topical formulations for the management of anterior and posterior segment ocular diseases. Expert Opin Drug Deliv 2021; 18:1245-1260. [PMID: 33787441 DOI: 10.1080/17425247.2021.1909568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Atropine is an old-known drug which is gaining increasing attention due to the myriad of therapeutic effects it may trigger on eye structures. Nevertheless, novel applications may require more adequate topical formulations. AREAS COVERED This review aims to gather the existing knowledge about atropine and its clinical applications in the ophthalmological field when administered topically. Atropine ocular pharmacokinetics is paid a special attention, including recent evidences of the capability of the drug to access to the posterior segment. Ocular bioavailability and systemic bioavailability are counterbalanced. Finally, limitations of traditional dosage forms and potential advantages of under investigation delivery systems are analyzed. EXPERT OPINION Mydriasis and cyclopegia have been widely exploited for eye examination, management of anterior segment diseases, and more recently as antidotes of chemical weapons. Improved knowledge on drug receptors and related pathways explains atropine repositioning as an outstanding tool to prevent myopia. The ease with which atropine penetrates ocular tissues is a double edged sword, that is, while it ensures therapeutic levels in the posterior segment, the unspecific distribution causes a wide variety of untoward effects. The design of formulations that can selectively deliver atropine to the target tissue for each specific application is an urgent unmet need.
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Affiliation(s)
- Ines García Del Valle
- Departamento De Farmacología, Farmacia Y Tecnología Farmacéutica, I+D FarmaGroup, Facultad De Farmacia and Health Research Institute of Santiago De Compostela (IDIS), Universidade De Santiago De Compostela, Santiago De Compostela, Spain
| | - Carmen Alvarez-Lorenzo
- Departamento De Farmacología, Farmacia Y Tecnología Farmacéutica, I+D FarmaGroup, Facultad De Farmacia and Health Research Institute of Santiago De Compostela (IDIS), Universidade De Santiago De Compostela, Santiago De Compostela, Spain
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