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Ординатура / Офтальмология / Английские материалы / Clinical Ocular Toxicology Drug-Induced Ocular Side Effects_Fraunfelder, Chambers _2008.pdf
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Primary use

This potent narcotic analgesic is administered preand postoperatively and in the terminal stage of cancer for the relief of ­severe pain.

Ocular side effects

Systemic administration

Certain

1. Pupils

a.Miosis

b.Pinpoint pupils – toxic states

c.Absence of reaction to light

d.Mydriasis – withdrawal states

e.Anisocoria – withdrawal states 2. Decreased accommodation

3. Non-specific ocular irritation

a.Lacrimation

b.Photophobia

4. Eyelids or conjunctiva

a.Hyperemia

b.Erythema

c.Edema

d.Urticaria

e.Decreased blink rate 5. Ocular motility

a.Esotropia (on withdrawal)

b.Exotropia

Probable

1. Intranuclear ophthalmoplegia (toxic)

Possible

1. Horner’s syndrome

a.Ptosis

b.Increased sensitivity to sympathetic agents

Ocular teratogenic effects

Probable

1. Strabismus

Clinical significance

Heroin can cause pupillary changes, which are often used to identify probable users. Ocular irritation and conjunctival changes are common. However, recently Firth (2005), Kowal et al (2003) and Sutter and Landau (2003) have well documented that esotropia with double vision occurs with heroin withdrawal and its use can cause intermittent or persistent exotropia. Awareness of these ocular side effects is essential to avoid neurologic referrals. Heroin addiction has been associated­ with bacterial and fungal endophthalmitis, probably due to intravenous administration and impurities on an embolus basis. If undiagnosed and incompletely treated, these indirect drug-related entities can result in permanent loss of vision. Horner’s syndrome has been reported in chronic addicts. Withdrawal of diacetylmorphine in the addict may cause excessive tearing, irregular pupils and decreased accommodation.

In opiate-dependent mothers, primarily on methadone, Gill et al (2003) estimated at least a 10-fold increase over the general population of ocular strabismus.

References and Further Reading

Alinlari A, Hashem B. Effect of opium addiction on intraocular pressure. Glaucoma 7: 69, 1985.

Caradoc-Davies TH. Opiate toxicity in elderly patients. BMJ 283: 905, 1981. Cosgriff TM. Anisocoria in heroin withdrawal. Arch Neurol 29: 200, 1973. Crandall DC, Leopold IH. The influence of systemic drugs on tear constitu-

ents. Ophthalmology 86: 115, 1979.

Dally S, Thomas G, Mellinger M. Loss of hair, blindness and skin rash in heroin addicts. Vet Human Toxicol 24(Suppl): 62, 1982.

Firth AY. Heroin and diplopia. Addiction 100: 46–50, 2005.

Gill AC, Oei J, Lewis NL, et al. Strabismus in infants of opiate-dependent mothers. Acta Paediatr 92: 379–385, 2003.

Gomezz Manzano C, et al. Internuclear ophthalmopathy associated with opiate overdose. Medicina Clinica 94: 637, 1990.

Hawkins KA, Bruckstein AH, Guthrie TC. Percutaneous heroin injection causing heroin syndrome. JAMA 237: 1963,1977.

Hogeweg M, De Jong PTVM. Candida endophthalmitis in heroin addicts. Doc Ophthalmol 55: 63, 1983.

Kowal L, et al. Acute esotropia in heroin withdrawal: a case series. Binocul Vis Strabismus Q 18: 163–166, 2003.

Rathod NH, De Alarcon R, Thomson IG. Signs of heroin usage detected by drug users and their parents. Lancet 2: 1411, 1967.

Salmon JF, Partridge BM, Spalton DJ. Candida endophthalmitis in a heroin addict: a case report. Br J Ophthalmol 67: 306, 1983.

Siepser SB, Magargal LE, Augsburger JJ. Acute bilateral retinal microembolization in a heroin addict. Ann Ophthalmol 13: 699, 1981.

Sutter FK, Landau K. Heroin and strabismus. Swiss Med Wkly 133: 293–294, 2003.

Tarr KH. Candida endophthalmitis and drug abuse. Aust J Ophthalmol 8: 303, 1980.

Vastine DW, et al. Endogenous candida endophthalmitis associated with heroin use. Arch Ophthalmol 94:1805, 1976.

Generic names: 1. Hydromorphone hydrochloride (dihydromorphinone); 2. oxymorphone hydrochloride.

Proprietary names: 1. Dilaudid, Dilaudid-HP; 2. Numorphan.

Primary use

These hydrogenated ketones of morphine are used for the relief of moderate to severe pain.

Ocular side effects

Systemic administration

Certain

1. Decreased vision

2. Decreased accommodation

3. Pupils

a.Miosis

b.Pinpoint pupils – toxic states

c.Mydriasis – hypoxic states

4. Eyelids or conjunctiva

a.Allergic reactions

b.Urticaria

c.Contact dermatitis

Probable

1. Extraocular muscles

a.Nystagmus

b.Diplopia

arthritis treat to used agents and antagonists narcotic Analgesics, • 3 Section

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