Systemic Side Effects of Ophthalmic Drops

Abstract

Topical application of ocular drugs may cause serious adverse ocular or systemic side effects. Children are at greater risk for systemic side effects because ocular dosing is not weight-adjusted, and infants are especially vulnerable as a consequence of the inability to efficiently metabolize the drug, and/or an immature blood-brain barrier. Four pediatric patients are reported in whom treatment with topical brimonidine, a selective alpha-2 adrenoceptor agonist, indicated for the treatment of glaucoma, produced somnolence. Anti-glaucoma eyedrops that are not approved for use in children are still used frequently in pediatrics. Therefore, physicians should be aware of possible systemic side effects of ophthalmic drops.

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References

Palmer EA . How safe are ocular drugs in pediatrics? Ophthalmology. 1986;93:1038-1040.

Juzych MS , Robin AL , Novack GD . Alpha-2 agonists in glaucoma therapy. In Zimmerman TJ , Kooner KS , Sharir M , Fechtner RD (eds): Textbook of Ocular Pharmacology. Philadelphia: Lippincott-Raven, 1997:247-254.

Hoffman BB , Lefkowitz RJ . Catecholamines, sympathomimetic drugs, and adrenergic receptor antagonists. In Hardman JG , Limbird LE , Molinoff PB , Ruddon RW (eds): Goodman and Gilman’s The Pharmacological Basis of Therapeutics. New York: McGraw-Hill, 1996:199-248.

Stein B , Volans GN . Dixarit overdose: the problem of attractive tablets. BMJ. 1978;2:667-668.

Schuman JS , Horwitz B , Choplin NT , et al. A 1-year study of brimonidine twice daily in glaucoma and ocular hypertension. A controlled, randomized, multicenter clinical trial. Arch Ophthalmol. 1997;115:847-852.

Reid JL . Alpha-adrenergic receptors and blood pressure control. Am J Cardiol. 1986;57:6E-12E.

Enyedi LB , Freedman SF . Safety and efficacy of brimonidine in children with glaucoma. J AAPOS. 2001;5:281-284.

Berlin RJ , Lee UT , Samples JR , et al. Ophthalmic drops causing coma in an infant. J Pediatr. 2001;138:441-443.

Carlsen JO , Zabriskie NA , Kwon YH , et al. Apparent central nervous system depression in infants after the use of topical brimonidine. Am J Ophthalmol. 1999;128:255-256.

10.

Korsch E , Grote A , Seybold M , Soditt V . Systemic adverse effects of topical treatment with brimonidine in an infant with secondary glaucoma [letter]. Eur J Pediatr. 1999;158:685.

11.

Walters G , Taylor RH . Severe systemic toxicity caused by brimonidine drops in an infant with presumed juvenile xanthogranuloma [letter]. Eye. 1999;13:797-798.

12.

Passo MS , Palmer EA , vanBuskirk EM . Plasma timolol in glaucoma patients. Ophthalmology. 1984;91:1361-1363.