OPHTHALMOLOGIC EMERGENCIES IN THE PATIENT WITH DIABETES

Fellowship of Vitreous and Retina,

Basir Eye Center, Tehran, Iran.

Abstract

Patients with diabetes mellitus are susceptible to a variety of ophthalmologic problems. Blindness is among the most feared medical conditions. This article focuses on rapidly progressive eye symptoms and problems that require emergent attention.

Diabetic retinopathy is the most common cause of blindness in adults aged less than 75 years. Clinicians must be able to recognize proliferative diabetic retinopathy and diabetic macular edema which need urgent ophthalmologic referral and photocoagulation laser treatment to limit the progression of retinal disease and to protect vision.

Other emergent conditions discussed herein are the evaluation of vascular events, ocular motor nerve palsies, corneal erosion syndrome, and severe eye infections including endophthalmitis and mucormycosis.

 Ocular Side Effects of Systemic Drugs (Anterior Segment)

Professor of Ophthalmology

Shahid Beheshti University of Medical Sciences

Torfeh Eye Hospital

: Abstract

Commonly reported ocular side effects of systemic drugs include abnormal vision, blurred vision, poor focusing ability, Dry/Irritated eye, color perception change and altered pupil Size.

The eye, because of its blood supply and relatively small mass, exhibits an unusually high to toxic substances. Drug molecules present in circulation can reach the ocular structures by way of the uveal or retinal vasculature. The choroid, sclera and ciliary body have thin, fenestrated walls for drug molecules to pass. Small, lipid soluble molecules pass freely into the aqueous humor, and can further diffuse into avascular structures such as the lens, cornea and trabecular meshwork

Drug molecules that enter by means of the uveal circulation exit the eye from the Canal of Schlemm, ciliary body or may diffuse into adjacent anatomical structures. Drugs from the retinal circulation can re-enter the systemic circulation, diffuse into the vitreous and anatomical structures, or get actively transported out.

Determination of drug reactions depends on amount of drug administration, nature of Drug, route of administration, pathophysiologic variables, age and gender, multiple drug therapy, drug interaction and history of allergies to drugs

Many systemic drugs are associated with: Dry-eye related sign and symptoms, conjunctivitis, corneal problems and the lens including: beta blockers, oral diuretics (change the tear film), oral contraceptives, antipsychotics (phenothiazine, thioridazine, chlorpromazine,), tricyclic antidepressant, anticholinergics (atropine, scopolamine),

Isotretinoin(decreased meibomian gland function- deficiency of normal lipid layer in tear film) , antihistamine, corticosteroids, amiodarone (Cordarone),Chemotherapy drugs, Immunosuppressive medications and topiramate

 Conclusion: Many systemic drugs can produce ocular and visual side effect which range from mild to severe and can be even vision threatening. A careful and detailed case history is necessary to be aware of patient's medical history. It is very important that these ocular side effects from systemic drug use be reported and addressed timely. These visual side effects should be recognized at the earliest to minimize serious complications and to plan appropriate intervention by modification of dosage or use of alternative drugs

February 2021

mhrabie@yahoo.com

Drug-induced retinal toxicity

چشم پزشک،فوق تخصص شبکیه، استاد دانشگاه علوم پزشکی شهید بهشتی

Drug-induced retinal toxicity can occur from the use of systemic, intravitreal, or topical medications. Despite the presence of the blood-ocular barrier, the retina is vulnerable to toxic effects of systemic medications leading to dysfunction and retinal degeneration. These toxicities can be categorized as damage to the retinal pigment epithelium and photoreceptor complex, vascular damage, ganglion cell or optic nerve damage, cystoid macular edema, crystalline retinopathy, uveitis, changes in color vision and electroretinography, and other miscellaneous effects. Many systemic drugs reach the retina through the vascular supply. Aminoquinolines induce a characteristic bull's eye maculopathy. hydroxychloroquine ocular toxicity includes keratopathy, ciliary body involvement, lens opacities, and retinopathy. Retinopathy is the major concern: others are more common but benign. The incidence of true hydroxychloroquine retinopathy is exceedingly low. Although its pathogenesis is unclear, risk factors include: daily dosage of hydroxychloroquine, cumulative dosage, duration of treatment, coexisting renal or liver disease, patient age, and concomitant retinal disease. Patients usually complain of difficulty in reading, decreased vision, missing central vision, glare, blurred vision, light flashes, and metamorphopsia. They can also be asymptomatic. Most patients have a bull's eye fundoscopic appearance. All patients have field defects including paracentral, pericentral, central, and peripheral field loss. Most patients have visual loss. Some patients with advanced retinopathy may experience deteriorating visual acuity even after cessation of treatment. Phenothiazines bind to melanin granules and can cause a severe phototoxic retinopathy. Typical tamoxifen retinopathy manifests as crystalline deposits in the inner retina. Some patients treated with retinoids have decreased night vision and abnormal dark-adaptation. In this review, we tried to present some features of retinal toxicity developed after common systemic drug usage.

ارزیابی تشخیصی و درمانی جسم خارجی در سگمان قدامی

متخصص چشم پزشک و مرکز تحقیقات نگاه و سلامت غرب

از آنجایی که اجزای سگمان قدامی شامل ملتحمه، قرنیه،اتاق قدامی ،آیریس،اتاق خلفی، لنز می باشد دانستن تشخیص و انتخاب درمان اهمیت بسزایی دارد.

جسم خارجی پس از ترومای شارپ به چشم میتواند قسمتی یا کل اجزای چشم را درگیر کند.

جسم خارجی درملتحمه با علایم کمتری ازسایردرگیری های چشمی همراه است درحالیکه جسم خارجی درقرنیه میتواند سطحی و یا کل لایه های قرنیه را درگیر کرده باشد لذا محل قرارگرفتن جسم خارجی، سرعت ورود ، اندازه نوع جسم خارجی / زمان ورودجسم خارجی تا معاینه مهم است.  در معاینه اولیه هر دوچشم بایستی معاینه شوند.

شایعترین نوع جسم خارجی : آهن ، استیل ، شیشه ، سنگ، چوب و پلاستیک است.

علایم اصلی شامل : قرمزی ، خونریزی ، احتقان ، اشک ریزش ، حساسیت به نور ، خارش ، کم بینایی ، تغییردرشکل مردمک می باشد.

بیشترین افراد درگیر شامل : کشاورزان ، کارگران شاغل در گاراژ ها ، نجارها و سنگ تراشها می باشند.

اگرعلایم ذیل وجود داشت به چشم پزشک ارجاع داده شود : هایفما ( خون دراتاق قدامی به هردلیل ) / صدمه به قرنیه / صدمه به اسکلرا ، تورم پلک، خونریزی زیر ملتحمه، تغییر در شکل مردمک ، کم عمق شدن اتاق قدامی و لک قرنیه است.

ارزیابی شامل : معاینه چشمها ، افتالموسکوپ مستقیم و غیرمستقیم، معاینه با اسلیت لامپ،او سی تی سگمان قدامی، یو بی ام، اولتراسوند ، الکترورتینوگرام ، ایکس ری، سی تی اسکن میباشد.

درمان : جسم خارجی بایددراورده شود. مگرجنس ان خنثی یااستریل باشد. جسم خارجی در قرنیه را با سوزن شماره 25 میتوان خارج کرد و درصورتی که در عنبیه باشد و یا باعث اب مروارید شده باشد نیاز به جراحی است.

توجه کنید که  نباید مالش چشم صورت گیرد و فقط از محافظ چشم استفاده شود و به متخصص ارجاع شود.

پیش اگهی مربوط است به : بهترین حدت بینایی اولیه، وجودمارکوس گان، زمان ورودجسم خارجی تامعاینه توسط متخصص، وضعیت اولیه شبکیه ، پارگی اسکلرا، مکانیزم صدمه،نوع جسم خارجی، خونریزی ویتره