Ocular drugs allergic reactions

Adverse effects associated with ocular drugs are not imcommon, bnt serious reactions are extremely rare. These adverse reactions are nsnally manifestations of drug hypersensitivity (allergy) or toxicity. The allergic or toxic reaction usually occurs locally in the ocular tissues. Occasionally, as in erythema multiforme potentiated by sulfonamide agents, adverse reactions can manifest as a systemic response. 

Ocular Effects. Timolol may cause some adverse ocular effects (Box 10-3). A local allergic reaction can occur.This allergic reaction manifests as a blepharoconjunctivitis, with erythema and edema of the lids. The reaction can occur as early as the first month of therapy. Management may include changing to another P-blocker or other class of drug. 

Among the treatment options, topical decongestants, topical and oral antihistamines, mast cell stabilizers, dual-action/multiaction drugs, and certain nonsteroidal antiinflammatory agents have proven useful for alleviating the signs and symptoms associated with ocular allergic reactions. Homeopathic preparations have also become of interest to the ophthalmic community, and their scientific... 

Numerous systemic drugs have been implicated, including the penicillins and sulfonamides, which can cause swelling of the lids and conjunctiva as part of a generalized urticaria or localized angioneurotic edema. Other drugs implicated in ocular allergic reactions are antidepressants, antipsychotics, antihypertensives, antirheumatics, sedatives, and hypnotics. 

Observational studies Topical bevacizumab (5 mg/ml five times a day for 0.5-12 months) was used in 27 patients (30 eyes) with corneal neovascularization due to several causes and not responding to conventional therapy [1 ]. In five patients (five eyes) new epithelial defects developed (which could have been due to the underlying disease). There were no drug-related ocular or systemic adverse events or allergic reactions. 

Observational studies The short-term and long-term safety of topical bevacizumab 5 mg/ml for progressive corneal neovascularization secondary to a variety of corneal diseases and not responding to conventional anti-inflammatory treatment have been evaluated in 30 eyes of 27 patients Five patients (five eyes) developed new corneal epithelial defects. The authors warned against using bevacizumab in patients with epithelial defects and neurotrophic keratopathy. There were no allergic reactions, ocular drug-related complaints, or systemic adverse reactions. 

Ocular complications are rare with systemic use of this class of drugs. Lid edema, conjunctivitis, chemosis, anterior uveitis, and scleral reactions have been reported with high-dose administration of sulfenilamide. The observed reactions appear to be analogous to systemic hypersensitivity reactions, such as urticaria and edema, seen in some patients who are allergic to sulfonamides. Several cases of Stevens-Johnson syndrome have been reported in patients of Japanese or Korean descent who were given oral metha-zolamide, a sulfonamide used to decrease lOP. Stevens-Johnson syndrome tends to show acute ocular involvement in 69% of affected individuals.This is stratified into mild ocular involvement in 40%, moderate in 25%, and severe in 4%. Late complications can occin and are usually in the form of severe ocular surfece disease and trichiasis. 

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