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Ординатура / Офтальмология / Английские материалы / Clinical Ocular Toxicology Drug-Induced Ocular Side Effects_Fraunfelder, Chambers _2008.pdf
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effects side ocular induced supplement dietary and medicine Herbal •  9 PART  

Ocular side effects

Local ophthalmic use or exposure

Certain

1. Allergic conjunctivitis (severe)

2. Angioedema

Clinical significance

Chamomile tea, which is a common drink worldwide, is made from the dried flower heads of the German or common chamomile plant. There is strong evidence that this tea, when applied topically in or around the eye, can cause a severe conjunctivitis. Subiza et al (1990) described seven patients who rinsed their eyes with chamomile tea to treat styes and runny, irritated eyes. All subjects developed severe conjunctivitis, with angioedema occurring in two patients. All seven subjects had a history of seasonal allergic rhinitis.

A possible mechanism for these patients’ conjunctivitis could be sensitivity to the allergens present in Matricaria chamomilla pollen. Cross-reactivity with other allergenic pollens to which the patient is already sensitive could lead to the severe conjunctivitis observed in

Subiza’s study. Because patients are using chamomile to treat their

eyes, clinicians should recognize the possibility of Matricaria cham- Fig. 9.1  Canthaxanthine crystalline retinopathy. omilla sensitivity in cases of what appears to be allergic conjunctivi-

tis, especially in patients who already have an atopic history.

References and Further Reading

Subiza J et al. Allergic conjunctivitis to chamomile tea. Ann Allergy 65: 127–132, 1990.

Herbal or supplement name: Chrysanthemum (lice

shampoo). (Fig. 9.2)

Primary use

Pyrethrum (Chrysanthemum cinerarifolium) is used as an ­insecticide for scabies, head lice, crab lice and their nits. Not Nice to Lice® (NNTL) shampoo is used to kill head lice and their nits. The ingredients of the latter, according to the product label, include purified water, anionic/non-ionic surfactant blend, glycerin, enzymes and peppermint oil.

around the eyes (i.e. lice shampoo on the head) but it is unusual for the reaction to cause more than transient eye irritation or red eye. Specifically, reports of corneal abrasions are worrisome, as patients will need to seek emergency treatment due to severe ocular pain and the risk of a bacterial infection superimposed on the corneal epithelial defect. Corneal abrasions may be due to the proteolytic enzymes present in the shampoo preparation.

From the available data, all adverse reactions were immediate and resolved after 1–2 days after discontinuation of the product. The dosage in all patients was per manufacturer instructions for use of Not Nice to Lice®; however, the concentration of pyrethrum is unknown in products such at NNTL and others.

References and Further Reading

Fraunfelder FW, Fraunfelder FT, Goetsch RA. Adverse ocular effects from over-the-counter lice shampoo. Arch Ophthalmol 121: 1790-1791, 2003.

Ocular side effects

Local ophthalmic use or exposure

Certain 

1. Keratitis

2. Irritative conjunctivitis

3. Allergic conjunctivitis (severe)

4. Corneal abrasions

Clinical significance

From the WHO and the National Registry, there are 54 reports of keratitis and 19 reports of irritative conjunctivitis from topical use of pyrethrum, which presumably got into the eye of the patients inadvertently. In addition, there are 15 case reports of severe surface ocular reactions from Not Nice to Lice (Ginesis, Nashville, Tennesee, USA) which got into the eyes of the user. Seven of these cases were corneal abrasions. It may not be unusual for eye irritation to occur when a topical solution is used

Herbal or supplement name: Datura.

Primary use

The dried leaves of this flower are used to treat inflammation of the eye as well as asthma, bronchitis, influenza and coughs. The leaves contain alkaloids that are anticholinergic and parasympatholytic in extremely varying concentrations. Jimson weed (Datura stramonium) is the main member of this genus utilized for its potential therapeutic value.

Ocular side effects

Systemic administration

Certain 

1.  Pupils – mydriasis

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