effects side ocular induced-Drug • 7 t Pa r

Lubeck MJ. Effects of drugs on ocular muscles. Int Ophthalmol Clin 11(2): 35, 1971.

Waisbren BA, Smith MB. Hypersensitivity to meperidine. JAMA 239: 1395, 1978.

Generic name: Pentazocine.

Proprietary name: Talwin.

Primary use

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

Ocular side effects

Systemic administration

Certain

1. Miosis

2. Decreased vision

3. Visual hallucinations

Probable

1. Nystagmus

2. Diplopia

3. Lacrimation – abrupt withdrawal states

4. Decreased accommodation

5. Eyelids or conjunctiva

a.Erythema

b.Conjunctivitis – non-specific

c.Edema

d.Urticaria

6. Decreased spontaneous eye movements

Possible

1. Oculogyric crisis

Clinical significance

Ocular side effects due to pentazocine are usually insignificant and reversible. Miosis is the most frequent and is seen routinely even at suggested dosage levels. Although visual complaints are seldom of major consequence, diplopia may be incapacitating. Vivid visual hallucinations, some of which are threatening, have been reported with this drug. Once pentazocine is discontinued, the hallucinations cease. Burstein and Fullerton (1993) reported oculogyric crisis possibly related to this drug.

References and Further Reading

Belleville JP, Dorey F, Bellville JW. Effects of nefopam on visual tracking. Clin Pharmacol Ther 26: 457, 1979.

Burstein AH, Fullerton T. Oculogyric crisis possibly related to pentazocine. Ann Pharm 27(7–8): 874–876, 1993.

Davidson SI. Reports of ocular adverse reactions. Trans Ophthalmol Soc UK 93: 495-510, 1973.

Gould WM. Central nervous disturbance with pentazocine. BMJ 1: 313–314, 1972.

Jones KD. A novel side-effect of pentazocine. Br J Clin Pract 29: 218, 1975.

Martin WR. Opioid antagonists. Pharmacol Rev 19: 463, 1967.

SECTION 4

Agents used in Anesthesia

Class: Adjuncts to Anesthesia

Generic name: Hyaluronidase.

Proprietary names: Amphadase, Hydase, Vitrase.

Primary use

This enzyme is added to local anesthetic solutions to enhance the effect of infiltrative anesthesia. It has also been used in paraphimosis, lepromatous nerve reactions and in the management of carpal tunnel syndrome.

Ocular side effects

Subconjunctival or retrobulbar injection

Certain

1. Eyelids or conjunctiva

a.Allergic reactions

b.Conjunctivitis – follicular

c.Angioneurotic edema

2. Irritation

3. Myopia

4. Astigmatism

5. Decreases the length of action of local anesthetics 6. Increases the frequency of local anesthetic reactions

Probable

1. Allergic reaction simulated expulsive choroidal or retro­ bulbar hemorrhage

2. May spread infection

Possible

1. May spread tumor

2. Decrease local anesthetic toxicity to adjacent extra ocular muscles and nerves

Conditional/Unclassified

1. Cystoid macular edema

Clinical significance

Adverse ocular reactions due to periocular injection of hyaluronidase are either quite rare or masked by postoperative surgical reactions. Subconjunctival injection of this drug causes myopia and astigmatism secondary to changes in the corneal curvature. This is a transitory phenomenon with recovery occurring within 2–6 weeks. Irritative or allergic reactions are often stated to be due to impurities in the preparation since pure hyaluronidase is felt to be non-toxic. Minning (1994) reported allergic reactions secondary to retrobulbar hyaluronidase. This occurred as an acute process simulating an expulsive choroidal or retrobulbar hemorrhage. Massive retrobulbar, peribulbar and intraorbital swelling may occur. Cases similar to this have been reported to the National Registry. Hyaluronidase decreases the duration of action of local anesthetic drugs by allowing them to diffuse out of the tissue more rapidly. Brown et al (1999) and Jehan et al (2001) pointed out that hyaluronidase may be important in decreasing or preventing damage from local anesthetics on adjacent extraocular muscles and nerves. This may occur, in part, by diffusion of the anesthetic, thereby decreasing the