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

d.Pruritis

9. Ptosis (opium)

Probable

1. Accommodative spasm

2. Diplopia

Possible

1. Myopia

2. Keratoconjunctivitis

Local ophthalmic use or exposure – morphine

Certain

1. Miosis

2. Increased intraocular pressure

Ueyama H, Nishimura M, Tashiro C. Naloxone reversal of nystagmus associated with intrathecal morphine [letter]. Anesthesiology 76: 153, 1992.

Generic name: Pethidine hydrochloride (meperidine).

Proprietary name: Demerol.

Primary use

This phenylpiperidine narcotic analgesic is used for the relief of pain, as a preoperative medication and to supplement surgical anesthesia.

Epidural or intravenous exposure

Certain

1. Vertical nystagmus

Ocular teratogenic effects

Probable

1. Increased incidence of strabismus

Clinical significance

These narcotics seldom cause significant ocular side effects, and all proven drug-induced toxic effects are transitory. Miosis is the most frequent ocular side effect and is commonly seen at therapeutic dosage levels. Ocular side effects reported in longterm addicts may include color vision or visual field changes, which are probably due to vitamin deficiency rather than to the drug itself. Withdrawal of morphine or opium in the addict may cause excessive tearing, irregular pupils, decreased accommodation and diplopia. Epidural (Fish and Rosen 1990) and intravenous opioids (Henderson and Wijdicks 2000) have been reported to cause vertical nystagmus. Castano and Lyons (1999) recently reported that intravenous morphine could cause eyelid pruritus.

Gill et al (2003) reported that the incidence of strabismus in infants of opiate-dependent mothers is at least 10 times greater then that seen in the general population.

References and Further Reading

Aminlari A, Hashem B. Effect of opium addiction on intraocular pressure. Glaucoma 7: 69, 1965.

Andersen PT. Alopecia areata after epidural morphine. Anesth Analg 63: 1142, 1984.

Castano G, Lyons CJ. Eyelid pruritus with intravenous morphine. J Am Assoc­ Pediatr Ophthalmol Strabismus 3(1): 60, 1999.

Crandall DC, Leopold IH. The influence of systemic drugs on tear constituents. Ophthalmology 86: 115, 1979.

Fish DJ, Rosen SM. Epidural opioids as a cause of vertical nystagmus. Anesthesiology­ 73: 785-786, 1990.

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

Henderson RD, Wijdicks EFM. Downbeat nystagmus associated with intravenous patient-controlled administration of morphine. Anesth Analg 91: 691-692, 2000.

Murphy DF. Anesthesia and intraocular pressure. Anesth Analg 64: 520, 1985.

Shelly MP, Park GR. Morphine toxicity with dilated pupils. BMJ 289: 1071, 1984.

Stevens RA, Sharrock NE. Nystagmus following epidural morphine. Anesthesiology 74: 390-391, 1991.

Ocular side effects

Systemic administration

Probable

1. Pupils

a.Mydriasis

b.Miosis

c.Decreased reaction to light (overdose) 2. Decreased intraocular pressure

3. Decreased vision

4. Eyelids or conjunctiva

a.Allergic reactions

b.Erythema

c.Urticaria

5. Visual hallucinations

Possible

1. Nystagmus

2. Ocular signs of drug-induced Parkinson’s disease

a.Paralysis of extraocular muscles

b.Ptosis

c.Diplopia

Inadvertent ocular exposure

Certain

1. Blepharitis

2. Conjunctivitis – non-specific

Clinical significance

None of the ocular side effects due to pethidine are of major clinical importance and all are transitory. Miosis is uncommon at therapeutic dosages and seldom significant. Mydriasis and decreased pupillary light reflexes are only seen in acute toxicity or in long-term addicts. Decrease in intraocular pressure is minimal. Ocular side effects, such as blepharitis or conjunctivitis, have been seen secondary to pethidine dust.

References and Further Reading

Bron AJ. Vortex patterns of the corneal epithelium. Trans Ophthalmol Soc UK 93: 455, 1973.

Carlson VR. Individual pupillary reactions to certain centrally acting drugs in man. J Pharmacol Exp Ther 121: 501–506, 1957.

Goetting MG, Thirman MJ. Neurtoxicity of meperidine. Ann Emerg Med 14: 1007, 1985.

Hovland KH. Effects of drugs on aqueous humor dynamics. Int Ophthalmol Clin 11(2): 99, 1971.

Johnson DAW. Drug-induced psychiatric disorders. Drugs 22: 57, 1981.

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

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