Eye drops preservative as the cause of corneal band keratopathy in long-term pilocarpine hydrochloride treatment.

The aim is to present a patient with severe bilateral corneal complications after long-term antiglaucoma treatment with 1% pilocarpine hydrochloride (Pilokarpin, Pliva, Zagreb, Croatia) and its management. A patient with narrow-angle glaucoma treated with 1% topical pilocarpine hydrochloride eye drops for the last twenty years complained of impaired vision, intermittent visual haloes and eye redness. Ophthalmologic examination showed bilateral band keratopathy, peripheral laser iridotomy, medicamentous myosis, brown nuclear cataract, and synchysis scintillans of his right eye. Band keratopathy was thought to have resulted from the presence of the preservative phenylmercuric nitrate in the pilocarpine hydrochloride eye drops. Treatment of the patient consisted of two separate procedures for both eyes, i.e. phaco trabeculectomy and six months later corneal procedure including abrasion of corneal epithelium followed by removal of the superficial stromal calcium deposits by means of a 3.75% ethylenediaminetetraacetic (EDTA) solution. After phaco trabeculectomy, visual acuity was 0.8 on both eyes. Bilateral visual improvement with visual acuity 1.0 was recorded after corneal treatment with EDTA. In conclusion, one must be aware of preservative complications in long-term topical use, such as band keratopathy that can be visually incapacitating. Surgical treatment using EDTA is safe and effective treatment for band keratopathy.

Unilateral mydriasis due to hemorrhoidal ointment.

BACKGROUND: The finding of a unilaterally dilatated pupil in a patient who is otherwise alert and unimpaired can pose an interesting diagnostic problem. Algorithms have outlined the approach to evaluating anisocoria, but do not stress the importance of toxic exposures. CASE REPORT: A patient with a history of depression and chronic headaches was referred to the emergency department from an ophthalmologist's clinic with the findings of asymmetrically dilatated pupils and blurred vision. Detailed history revealed that for several weeks before the onset of symptoms, the patient applied to her eyelids hemorrhoidal ointment that contained an active ingredient known to produce mydriasis. CONCLUSION: In the absence of neurologic deficits, clinical history should search for a toxic or pharmacologic etiology of abnormal mydriasis. A detailed physical examination and bedside diagnostic maneuvers can help distinguish benign causes of an abnormally dilatated pupil from more serious causes relating to central nervous system lesions, potentially sparing the patient from unnecessary neuroimaging.

Chlorhexidine anaphylaxis: case report and review of the literature.

Chlorhexidine is a widely used antiseptic and disinfectant. Compared to its ubiquitous use in medical and non-medical environments, the sensitization rate seems to be low. Multivarious hypersensitivity reactions to the agent have been reported, including delayed hypersensitivity reactions such as contact dermatitis, fixed drug eruptions and photosensitivity reactions. An increasing number of immediate-type allergies such as contact urticaria, occupational asthma and anaphylactic shock have been reported. In the case report, we describe anaphylaxis due to topical skin application of chlorhexidine, confirmed by skin testing and sulfidoleukotriene stimulation test (CAST(R): cellular antigen stimulation test). The potential risk of anaphylactic reactions due to the application of chlorhexidine is well known, especially that application to mucous membranes can cause anaphylactic reactions and was therefore discouraged. The use of chlorhexidine at a 0.05% concentration on wounds and intact skin was so far thought to be safe. Besides our patient, only one other case of severe anaphylactic reaction due to application of chlorhexidine on skin has been reported. Hypersensitivity to chlorhexidine is rare, but its potential to cause anaphylactic shock is probably underestimated. This review should remind all clinicians of an important potential risk of this widely used antiseptic.

Oral lichenoid lesions caused by allergy to mercury in amalgam fillings.

Oral lichenoid lesions (OLL) or lichen-planus-like lesions are often idiopathic. Our aim was to determine whether OLL can be caused by allergy to mercury in amalgam fillings, and whether resolution of OLL occurs after replacement of amalgam with other dental fillings. Patients with only OLL (except for 1 case with cutaneous lichen planus) referred for patch testing during 1985-1994 to the Contact and Occupational Dermatitis Clinic of the Skin & Cancer Foundation, Darlinghurst, were reviewed. Patch tests were performed with 1% mercury, 1% ammoniated mercury, 0.1% thimerosal, 0.1% mercuric chloride, 0.05% phenylmercuric nitrate and an amalgam disc, using Finn Chambers occluded for 2 days, 19 patients (17 women and 2 men; age range: 28-72 years) had OLL in close contact with amalgam fillings and showed positive patch test reactions to mercury compounds, 16 out of 19 patients had their amalgam fillings replaced. In 13 patients, the OLL healed. 1 patient had marked improvement. 1 patient had no improvement and developed multiple oral squamous cell carcinoma. In conclusion, OLL can be caused by allergy to mercury in amalgam fillings. Replacement of amalgam with other dental fillings usually results in resolution of OLL and is recommended for cases with positive patch test reactions to mercury compounds.

Sensitization to thimerosal (Merthiolate) is still present today.

The results on thimerosal (Merthiolate) hypersensitivity of a retrospective study, together with the relevant data on thimerosal hypersensitivity referred to in the literature up to 1993, are presented. Positive patch test reactions to thimerosal (0.1% pet.) were observed in 32 (1.3%) of 2461 adult patients with suspected contact allergy examined in the period 1987-1992. 20 (0.8%) patients had a solitary positive patch test to thimerosal. The observed incidence is low. Clinical symptoms related to thimerosal hypersensitivity were observed in only 3 patients. The collected results are discussed with emphasis on the clinical implications of sensitization to thimerosal. It appears that a positive patch test to thimerosal is frequently clinically irrelevant.

The effect of a surgical lubricant on in vivo sperm penetration of cervical mucus.

The implications of these data is that coital lubricants may impair fertility of some couples. Unfortunately, conception was not an end point on this study, and our conclusions must be considered inferential. Nevertheless, the results from this study lead us to recommend avoidance of surgical lubricants by couples attempting pregnancy.

Vaccination despite thimerosal sensitivity.

Thimerosal sensitivity is extremely common in Austria, being surpassed as a contact allergen only by nickel. This high incidence is still rising and is probably due to the frequent vaccinations which are performed in Austria. Most of the patch-test-positive patients had recently been immunized with thimerosal-containing vaccines, and no other obvious sources of exposure to thimerosal could be found. On retrospective questioning, 48 out of 50 patients had had no problems with their recent immunization; the 2 who reported massive local reactions had received their injections, against the recommendation of the manufacturer, subcutaneously. In a prospective study, 12 thimerosal-sensitized persons received their follow-up immunization at our department, and no side effects occurred. This enables us to conclude that sensitization had occurred through vaccines, but that those amounts of thimerosal delivered i.m. are not sufficient to elicit clinical symptoms. Patch-test positivity to thimerosal thus represents no contra-indication to i.m. immunization with thimerosal-containing vaccines.

Atypical band keratopathy following long-term pilocarpine treatment.

Two patients with an atypical form of band keratopathy following long-term pilocarpine treatment are described. The keratopathy is thought to have resulted from the presence of the preservative phenylmercuric nitrate in the pilocarpine drops. Symptoms of reduced acuity, visual haloes, and recurrent epithelial erosions were relieved by removal of the opacities.

L'echange des chromatides soeurs et L'exposition accidentalle L'acetate de phenyl-mercure

A gret number of children (1507) were seriously affected by the use of diapers processed with phenylmercury acetate, in order to obtain bacteriostatic effect. The cytogenetic study was performed in 38 children whose age ranged from 1 month to 5 years. Sister chromatid exchange (SCE) was analysed in peripheral blood. The exposed children were classified in groups taking into account the period in which they were in touch with diapers and the time elapsed from the interruption of the diapers used until cytogenetic study. The value of SCE in the control group (presurgical children) was: Mean ñ SE = 5.9 ñ 0.6. Exposed children from 3 to 15 months with 9 months of interruption lapse of the use of diapers showed a significative increase in SCE frequency (Mean ñ SE = 7.9 ñ 1.8) respect to the group of children with a period of interruption was more than 9 months (Mean ñ SE = 5.9 ñ 0.9) and the controls (p < 0.001). This study suggests that the lymphocyte may be susceptible to phenyl-mercure acetate clastogenic effect. If the agent is clastogenic it may have carcinogenic effects the these children should be considered as a risk population

Effects of mercurial compounds on adenine nucleotides of washed pig platelets.

The effects of methylmercuric chloride, mercuric chloride, and phenylmercuric acetate (10(-6) - 10(-3) mole/liter) on thrombin-induced release of adenine nucleotides from washed pig platelets were investigated. The inhibitory effects of mercurials were always reached when the higher thrombin concentration (0.74 units NIH/ml) was used. Incubation of washed pig platelets with methylmercuric chloride caused a decrease of intracellular level of platelet ATP and statistically significant changes in ATP/ADP ratio.

[Phenylhydrargyrum boricum in glycerin (Glycero-Merfen) in young children: undesirable mercury resorption in mouth mucosa even when free of lesions]. / Phenylmercuriborat in Glycerin (Glycero-Merfen) im Kleinkindesalter: unerwünschte Quecksilberresorption auch bei intakter Mundschleimhaut.

The formulation of phenylhydrargyrum boricum in glycerine (Glycero-Merfen) being frequently used in infants and young children, attention is drawn to the potentially symptomatic mercury absorption associated with its topical administration in that age group. This finding applies to both inflamed and normal oral mucosa. The use of this drug formulation in pediatric patients should be avoided.