Download Eyedrops can affect more than the eye

ESONT 7
Eyedrops can affect more than the eye
Stefanie Petrou-Binder MD
in Nürnberg
While ophthalmic eye drops
may contain a very small
amount of a given drug, nurses
and staff should remember that
these medications can still
have significant systemic side
effects, said Sabine Menkhaus
MD, University Eye Clinic
Magdeburg, Germany.
"When administered, eye
drops come into contact with
the conjunctiva and the
secretory membranes of the
tear canals, eventually
reaching the circulatory system
through the mucosa of the nose
and throat. One should not
underestimate the potential
systemic side effects that
ocular medications may
precipitate," Dr Menkhaus told
the 17th Congress of the
German Ophthalmic Surgeons
(DOC) in Nürnberg, Germany.
A good example of a very
commonly applied ophthalmic
medication that can cause
unwanted systemic side effects
is atropine. Atropine drops are
administered to achieve
mydriasis, which allows retinal
examination, refractive
measurement, and even the
dissolution of adhesions
between the iris and the lens.
Side effects to watch out for
include: fever, headache, facial
erythema, dry mouth, high
blood pressure, difficulty in
concentration, cramps (in
children), and blurry vision.
Patients should be advised not
to drive until this effect
subsides. Also, closed angle
glaucoma patients should not
receive mydriatic drugs, to
avoid a glaucoma attack.
Glaucoma medications
represent another group of
ophthalmic drugs that can
bring about unwanted systemic
reactions. For instance, beta
blockers (Tilomann,
Betamann, Vistagan,
Arutimol), which decrease the
production of aqueous humour,
may cause bradycardia,
reduced blood pressure,
bronchial asthma, and dry eye.
Cholinergic drugs such as
pilocarpine are used in
glaucoma therapy to increase
the flow of aqueous humour
and induce a narrow pupil.
They may also, in turn, worsen
vision in patients with
cataracts and reduce visual
acuity at night.
Both alpha-sympathotonics
(Iopidine and Alphagan) and
carbonic anhydrase blockers
(Trusopt, Azopt, Cosopt), on
the other hand, cause a
reduction in aqueous humour
production. They can be the
cause of allergy, fatigue and
headaches, with carbonic
anhydrase blockers leaving the
patient with a bitter, metallic
taste.
Other carbonic anhydrase
blockers like Diamox and
Glaupax tablets affect the
excretion of potassium in the
kidney, causing a low blood
potassium level (hypokalemia),
heart arrhythmias, exsiccation,
paraesthesias in the
extremities, and nausea.
Xalatan and Travatan are
prostaglandin analogues used
in glaucoma therapy. These
agents can cause an increase in
aqueous humour emptying and
a dark discoloration of the iris.
As these drugs may bring
about increased eyelash
growth, Dr Menkhaus
suggested applying it to both
eyes to achieve a better
cosmetic result.
Drugs that "get the red out"
function by causing a
vasoconstriction of the
conjunctival vessels. Dr
Menkhaus urged ophthalmic
professionals to remind their
patients not to abuse these
drugs as the eye can get used
to them over time. So much so,
that the eye may appear red
unless they are applied. These
drugs may also cause a rise in
blood pressure, daze and even
hallucinations.
Local, as opposed to
systemic, drug reactions are
varied. Reactions to
ophthalmic medications may
include eczema, for instance,
which results from eye drops
that come into contact with the
skin of the eyelids or cheeks.
The skin exerts an allergic
reaction from exposure to the
active ingredient or
conservation medium.
Antibiotic eye drops and eye
ointments are used for the
treatment of inflammations of
the lids, conjunctiva, cornea,
and lacrimal pathways. These
drugs may cause irritation in
the eye, but systemic side
effects are unlikely.
Dr Menkhaus pointed out
that local anaesthetic drops
such as Novesine or
Propakarakain POS, should
best be administered by the
doctor or staff during
treatments. She warned that if
used at home as a remedy for
chronic pain, a disruption in
the nutrition of the cornea may
occur, which could ultimately
lead to corneal ulcerations.
She asserted that eye drops
that contain corticosteroids are
a well-known cause of
increased intra-ocular pressure
(and glaucoma) and may
further catalyse the
development of lens
opacification (and cataract).
Also, patients with a healed
herpetic inflammation of the
eye may suffer a reactivation
of the viral disease when
receiving cortisone-containing
medications, unless anti-viral
eye ointment is administered
concomitantly.
Even iodine, which is
applied to the skin and
conjunctiva pre-operatively for
disinfection, may provoke an
allergic skin reaction or
exacerbate pre-existent
hyperthyroidism.
Because even the smallest
amount of an active substance
of a drug can cause systemic
side effects, Dr. Menkhaus
recommended a simple trick to
side-step potential adverse
reactions.
"After administering the eye
drops, the doctor should apply
slight pressure with his finger
on the descending tear canal
for approximately two
minutes. Any excess drops
should be carefully wiped
away and cleaned from the
eyelids and cheeks. This way
one can ensure that only a
minimal drug dose enters the
circulatory system, and reduce
the possibility of systemic
side-effects and the risk of
contact allergy on eye lids and
cheeks."
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NOVEMBER 2004
MAY 2005
SEPTEMBER 2005
SEPTEMBER 2006
26
19-20
10-14
9-13 LONDON, UK
XXIV Congress of the ESCRS &
ESONT Programme
Contact:ESCRS / ESONT
Temple House,Temple Road,Blackrock,
Co.Dublin,Ireland
Tel:+ 353 1 209 1100,
Fax:+ 353 1 209 1112
Email:[email protected]
BRUSSELS, BELGIUM
Annual Congress of BSONT (Belgian
Society of Ophthalmic Nurses &
Technicians)
Contact:Gert Princen
Email:[email protected]
MALMÖ, SWEDEN
Annual Meeting of the Swedish
Ophthalmic Nurses Society
Contact:Ulla Hurtig
Email:[email protected]
LISBON, PORTUGAL
XXIII Congress of the ESCRS &
ESONT Programme
Contact:ESCRS / ESONT
Temple House,Temple Road,Blackrock,
Co.Dublin,Ireland
Tel:+ 353 1 209 1100,
Fax:+ 353 1 209 1112
Email:[email protected]
calendar
January 2005
28-29
VEJLE, DENMARK
Annual Meeting of the Danish Ophthalmic
Nurses Society
Email:[email protected]
Web:www.dsr.dk/fs20
JUNE 2005
16-18
NYÍREGYHÁZA, HUNGARY
V Congress of the SHAO
(Hungarian Ophthalmic Assistants Society)
Contact:Dr.Kelenhegyi Csilla
Tel:+ 36 303 492 058
Email:[email protected]
DUOVISC ® Viscoelastic System
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Sodium
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in cannula detachment and the possibility of serious injury.
Precautions: Precautions are limited to those normally
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Although sodium hyaluronate and sodium chondroitin sulfate
are highly purified biological polymers, the physician should be
aware of the potential allergic risks inherent in the use of any
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PROVISC ® (Sodium Hyaluronate)
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Indications: PROVISC® Ophthalmic Viscosurgical Device is
indicated for use as an ophthalmic surgical aid in the anterior
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Contraindications: At present there are no known
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Precautions: Postoperative increases in intraocular pressure
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should be carefully monitored and appropriate therapy
instituted if significant increases occur. It is recommended that
PROVISC® Ophthalmic Viscosurgical Device be removed by
irrigation and/or aspiration at the close of surgery. Do not
overfill anterior chamber. PROVISC® Ophthalmic Viscosurgical
Device is obtained from microbial fermentation by a purified
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for allergenic response, this device, used in susceptible
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Contains Dry Natural Rubber.
Adverse Reactions: Postoperative inflammatory reactions
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CAUTION: FEDERAL (USA) LAW RESTRICTS THIS DEVICE TO
THE SALE BY OR ON THE ORDER OF A PHYSICIAN.
U.S. Patent Nos. 5,273,056; 5,876,379 and 6,051,560.
June 2006
19-20
COPENHAGEN, DENMARK
Congress of the Nordic Co-Operation of
Ophthalmic Nurses
Email:[email protected]
A
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ESONT EuroTimes Magazine October-December 2004