When a patient presents with a red eye and we reach for the prescription pad, it’s important to consider what the condition is, what is the best medication for the condition, or to consider no treatment at all.
[Continue reading…]Intraoperative Floppy Iris Syndrome (IFIS) Associated with Systemic Alpha-1 Blockers
October 20, 2008 By Leave a Comment
Intraoperative floppy iris syndrome (IFIS) is associated with the use of the systemic alpha-1 adrenergic antagonist, tamsulosin (Flomax®, Boehringer-Ingelheim Pharmaceuticals, Inc., Ridgefield, CT) [1- 7], commonly prescribed for Benign Prostatic Hyperplasia (BPH). IFIS is characterized by poor pre-operative pupil dilation and progressive miosis during cataract surgery which may lead to complications during what would otherwise be routine procedures. Billowing of a “floppy” iris in some cases may be associated with frank prolapse of a sector of the iris out of the main corneal incision but more commonly leads to damage through inadvertent contact with the phacoemulsification probe. In one prospective study, 90% of 167 eyes from patients taking tamsulosin exhibited some degree of IFIS during cataract surgery [5]. Tamsulosin is currently the only systemic alpha-1 antagonist which is selective for the alpha-1A receptor subtype [8], the predominant alpha receptor subtype present within the iris dilator. IFIS has also been reported with non-subtype specific alpha-1 adrenergic antagonists, such as terazosin (Hytrin®; Abbott Laboratories, Inc., North Chicago, IL), doxazosin (Cardura®; Pfizer Inc, New York, NY), and alfuzosin (Uroxatral®; Sanofi-Aventis, Paris, France). However, several prospective and retrospective studies suggest that IFIS is more likely to occur with tamsulosin than with the non- specific alpha-blockers [1-3, 6, 9]. Tamsulosin and alfuzosin are considered to be uroselective and are popular as they are less likely to cause postural hypotension [7].
[Continue reading…]Acute Angle Closure Glaucoma
October 3, 2008 By Leave a Comment
Acute angle glaucoma (AACG) is an ocular emergency and receives distinction due to its acute presentation, need for immediate treatment, and well- established anatomic pathology. Rapid diagnosis, immediate intervention, and referral can have profound effects on patient outcome and morbidity. Immediate treatment is essential to prevent optic nerve damage and vision loss.
Acute angle closure occurs when intraocular pressure (IOP) rises rapidly as a result of sudden blockage of the trabecular meshwork by the iris. Angle closure may occur in two ways: (1) the iris may be pushed forward up against the trabecular meshwork or (2) the iris may be pulled up against the trabecular meshwork. In either case, the position of the iris causes the normally open anterior chamber angle to close. Aqueous humor that should normally drain out of the anterior chamber is trapped inside the eye, thereby increasing the IOP.
[Continue reading…]Diabetic Retinopathy
July 8, 2008 By Leave a Comment
Diabetic retinopathy (DR) remains the leading cause of vision loss among American adults. The prevalence of diabetes continues to rise and is currently estimated by the CDC at 9.6% of adults over 20 years of age. Fortunately, most vision loss from DR is preventable with a combination of diabetic control and the treatment of ocular manifestations.
Diabetic control has proven to be the cornerstone of preventing retinopathy and vision loss. The risk of DR and vision loss is directly related to the duration of diabetes and the level of glycemic control. Other modifiable risk factors include hypertension and hyperlipidemia. In cases of visual impairment specifically due to macular edema, the use of oral glitazones has also been implicated as a contributing factor.
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