Page 931 - TNFlipTest

Toronto Notes 2019
Ocular Drug Toxicity
Ophthalmology OP41
Clinical Features
• painandnauseaattimeofinjury
• diplopia,restrictionofEOM
• infraorbitalandupperlipparesthesia(CNV2)
• enophthalmos(sunkeneye),periorbitalecchymoses
Investigations
• plainfilms:Waters’view(occipitomentalview) • CT:anteroposteriorandcoronalviewoforbits
Treatment
• refrainfromcoughing,blowingnose
• systemicantibioticsmaybeindicated
• surgeryiffracture>50%orbitalfloor,diplopianotimproving,orenophthalmos>2mm • maydelaysurgeryifthediplopiaimproves
Chemical Burns
• alkaliburnshaveaworseprognosisthanacidburnsbecauseacidscoagulatetissueandinhibitfurther corneal penetration
• poorprognosisifcorneaopaque,likelyirreversiblestromaldamage
• evenwithaclearcorneainitially,alkaliburnscanprogressforweeks–thus,veryguardedprognosis
Treatment
• immediatelyirrigatesiteofaccidentwithwaterorbufferedsolution
■ irrigate with eyelids retracted in emergency department with IV drip until pH physiologic ■ swab upper and lower fornices to remove possible particulate matter
• donotattempttoneutralizeanacidwithabase,orviceversa
• cycloplegicdropstodecreaseirisspasm(pain)andpreventsecondaryglaucoma(duetoposterior
synechiae formation)
• topicalantibioticsandpatching
• topicalsteroids(prescribedbyophthalmologist)todecreaseinflammation,usefor<2wkinthecaseofa
persistent epithelial defect
Ocular Drug Toxicity
Table 12. Drugs with Ocular Toxicity
Amiodarone
Atropine, benztropine
Bisphosphonates (Fosamax®, Actonel®) Chloroquine, hydroxychloroquine
Chlorpromazine Contraceptive pills
Digitalis
Ethambutol Haloperidol (Haldol®)
Indomethacin Interferon Isoniazid Nalidixic acid Steroids
Sulphonamides, NSAIDs Tamsulosin (Flomax®) Tetracycline Thioridazine
Vigabatrin Vitamin A toxicity Vitamin D toxicity
Corneal microdeposits and superficial keratopathy (vortex keratopathy) Rare: ischemic optic neuropathy
Pupillary dilation (risk of angle closure glaucoma) Inflammatory eye disease (iritis, scleritis, episcleritis)
Bull’s eye maculopathy Vortex keratopathy
Anterior subcapsular cataract
Decreased tolerance to contact lenses
Migraine
Optic neuritis
Central vein occlusion, benign increase in intracranial pressure
Yellow vision Blurred vision
Optic neuropathy
Oculogyric crises Blurred vision
Superficial keratopathy
Retinal hemorrhages and cotton wool spots Optic neuropathy
Papilledema
Posterior subcapsular cataracts
Glaucoma
Papilledema (systemic steroids)
Increased severity of HSV infections (geographic ulcers) Predisposition to fungal infections
Stevens-Johnson syndrome
Intraoperative Floppy Iris Syndrome, which can complicate cataract surgery Papilledema (associated with pseudotumour cerebri)
Pigmentary degeneration of retina
Retinal deposition with macular sparing, peripheral visual field loss Papilledema
Band keratopathy