effects side ocular induced-Drug  • PART7  

Generic name: Polymyxin B sulfate.

Proprietary names: Multi-ingredient preparations only.

Primary use

This bactericidal polypeptide is effective against Gram-negative bacilli, especially Ps. aeruginosa.

Ocular side effects

Systemic administration

Probable

1. Myasthenia gravis (aggravates)

a.Diplopia

b.Ptosis

c.Paresis of extraocular muscles 2. Decreased vision

3. Diplopia

4. Nystagmus

5. Mydriasis

Local ophthalmic use or exposure – topical application or subconjunctival

1. Injection

Certain

1. Irritation – ocular pain

2. Eyelids or conjunctiva – allergic reactions

a.Itching

b.Edema

c.Erythema

Probable

1. Myasthenia gravis (aggravates)

a.Diplopia

b.Ptosis

c.Paresis

2. Overgrowth of non-susceptible organisms

3. Anaphylactic reaction

Local ophthalmic use or exposure – intracameral injection­

Certain

1. Uveitis

2. Corneal edema

3. Lens damage

Clinical significance

Although ocular side effects due to polymyxin B sulfate are well documented, they are quite rare and seldom of major clinical importance. The drug is rarely used by itself as a topical ocular medication, so the true incidence of side effects is difficult to determine. Myasthenia gravis is transitory and does occur from topical ocular administration. To date, we are unaware of systemic polymyxin B sulfate toxicity from topical ocular ­medication other than transitory neuromuscular transmission defects, such as myasthenia gravis-type clinical syndrome. Some systemic absorption may occur, for example if the drug is given every hour for corneal ulcers. There are reports of anaphylactic reactions from topical polymyxin B-bacitracin applications. The clinically important side effects are secondary to intracameral injections where permanent changes to the cornea and lens have occurred.

References and Further Reading

Baldinger J, Weiter JJ. Diffuse cutaneous hypersensitivity reaction after dexamethasone/polymyxin B/neomycin combination eyedrops. Ann Ophthalmol 18: 95, 1986.

Francois J, Mortiers P. The injurious effects of locally and generally applied antibiotics on the eye. T Geneeskd 32: 139, 1976.

Hudgson P. Adverse drug reactions in the neuromuscular apparatus. ­Adverse Drug React Acute Poisoning Rev 1: 35, 1982.

Kaeser HE. Drug-induced myasthenic syndromes. Acta Neurol Scand 70(Suppl 100): 39, 1984.

Koenig A, Ohrloff C. Influence of local application of Isoptomax eye drops on neuromuscular transmission. Klin Monatsbl Augenheilkd 179: 109, 1981.

Lane RJM, Routledge PA. Drug-induced neurological disorders. Drugs 26: 124, 1983.

Stern GA, et al. Effect of topical antibiotic solutions on corneal epithelial wound healing. Arch Ophthalmol 101: 644, 1983.

Generic names: 1. Sulfacetamide; 2. sulfafurazole (sulfisoxazole); 3. sulfamethizole; 4. sulfamethoxazole; 5. sulfanilamide; 6. sulfasalazine; 7. sulfathiazole.

Proprietary names: 1. Ak-Sulf, Bleph-10, Centamide, Isopto Cetamide, Klaron, Ocusulf-10, Sodium Sulamyd, Sulf10, Sulfac, Vanocin; 2. Gantrisin; 3. Multi-ingredient preparation only; 4. Multi-ingredient preparation only; 5. Multiingredient­ preparation only; 6. Azulfidine; 7. Multi-ingredient preparation only.

Primary use

The sulfonamides are bacteriostatic agents effective against most Gram-positive and some Gram-negative organisms.

Ocular side effects

Systemic administration

Certain

1.Decreased vision

2.Myopia – transitory

3.Non-specific ocular irritation

a.Lacrimation

b.Photophobia

4.Keratitis

5.Problems with color vision

a.Color vision defect

b.Objects have yellow or red tinge

6.Periorbital edema

7.Visual hallucinations

8.Decreased anterior chamber depth – may precipitate angle-closure glaucoma

9.Eyelids or conjunctiva

a.Allergic reactions

b.Conjunctivitis – non-specific

c.Photosensitivity

d.Urticaria

e.Purpura

f.Pemphigoid lesion with or without symblepharon

g.Loss of eyelashes or eyebrows

10. Contact lenses stained yellow

11. Uveitis