RESUMO
ABSTRACT This report was written to describe a case of unilateral brimonidine-induced conjunctival lichen planus. Because the ophthalmic examination indicated chronic conjunctivitis or drug-induced pseudopemphigoid, the patient underwent thorough ophthalmic and systemic examinations, as well as conjunctival biopsy and direct immunofluorescence studies. A 71-year-old woman with unilateral left eye findings of chronic conjunctivitis was referred to our Ophthalmology Department. The patient reported that chronic conjunctivitis began shortly after she initiated use of topical brimonidine. Ophthalmic examination revealed foreshortening of the inferior fornix and symblepharon. Conjunctival biopsy revealed submucous lymphocytes and shaggy distribution of fibrinogen on direct immunofluorescence; this was suggestive of ocular lichen planus. No other systemic lesions were found that were consistent with the presentation of lichen planus. A good response was observed to topical cyclosporine treatment. To our knowledge, this may be the first report of unilateral ocular lichen planus without systemic findings. The correlation with the initiation of topical brimonidine suggests that this might be the first case of biopsy-confirmed brimonidine-induced ocular lichen planus.
RESUMO Este relato é para descrever um caso de líquen plano conjuntival unilateral induzido por brimonidina. Como o exame oftalmológico indicava conjuntivite crônica ou pseudopenfigóide induzido por medicamento, o paciente foi submetido a exames oftalmológicos e sistémicos completos, além de biópsia conjuntival e estudos de imunofluorescência direta. Uma mulher de 71 anos de idade com achados unilaterais do olho esquerdo de conjuntivite crônica foi encaminhada ao nosso departamento de Oftalmologia. A paciente relatou que a conjuntivite crônica começou logo após o início do uso da brimonidina tópica. O exame oftalmológico revelou encurtamento do fórnice inferior e do symblepharon. A biópsia conjuntival revelou linfócitos submucosos e distribuição felpuda de fibrinogênio na imunofluorescência direta; isso era sugestivo de líquen plano ocular. Não foram encontradas outras lesões sistêmicas compatíveis com a apresentação do líquen plano. Uma boa resposta foi observada no tratamento tópico com ciclosporina. Pelo nosso conhecimento, este pode ser o primeiro relato de líquen plano ocular unilateral sem achados sistêmicos. A correlação com o início da brimonidina tópica sugere que este pode ser o primeiro caso de líquen plano ocular induzido por brimonidina confirmado por biópsia.
Assuntos
Humanos , Feminino , Idoso , Doenças da Túnica Conjuntiva/induzido quimicamente , Tartarato de Brimonidina/efeitos adversos , Líquen Plano/induzido quimicamente , Anti-Hipertensivos/efeitos adversos , Biópsia , Ciclosporina/uso terapêutico , Túnica Conjuntiva/patologia , Doenças da Túnica Conjuntiva/patologia , Doenças da Túnica Conjuntiva/tratamento farmacológico , Imunossupressores/uso terapêutico , Líquen Plano/patologia , Líquen Plano/tratamento farmacológicoRESUMO
This report was written to describe a case of unilateral brimonidine-induced conjunctival lichen planus. Because the ophthalmic examination indicated chronic conjunctivitis or drug-induced pseudopemphigoid, the patient underwent thorough ophthalmic and systemic examinations, as well as conjunctival biopsy and direct immunofluorescence studies. A 71-year-old woman with unilateral left eye findings of chronic conjunctivitis was referred to our Ophthalmology Department. The patient reported that chronic conjunctivitis began shortly after she initiated use of topical brimonidine. Ophthalmic examination revealed foreshortening of the inferior fornix and symblepharon. Conjunctival biopsy revealed submucous lymphocytes and shaggy distribution of fibrinogen on direct immunofluorescence; this was suggestive of ocular lichen planus. No other systemic lesions were found that were consistent with the presentation of lichen planus. A good response was observed to topical cyclosporine treatment. To our knowledge, this may be the first report of unilateral ocular lichen planus without systemic findings. The correlation with the initiation of topical brimonidine suggests that this might be the first case of biopsy-confirmed brimonidine-induced ocular lichen planus.
Assuntos
Anti-Hipertensivos/efeitos adversos , Tartarato de Brimonidina/efeitos adversos , Doenças da Túnica Conjuntiva/induzido quimicamente , Líquen Plano/induzido quimicamente , Idoso , Biópsia , Túnica Conjuntiva/patologia , Doenças da Túnica Conjuntiva/tratamento farmacológico , Doenças da Túnica Conjuntiva/patologia , Ciclosporina/uso terapêutico , Feminino , Humanos , Imunossupressores/uso terapêutico , Líquen Plano/tratamento farmacológico , Líquen Plano/patologiaAssuntos
Antineoplásicos/efeitos adversos , Doenças da Túnica Conjuntiva/induzido quimicamente , Mesilato de Imatinib/efeitos adversos , Transtornos da Pigmentação/induzido quimicamente , Idoso , Doenças da Túnica Conjuntiva/patologia , Feminino , Neoplasias Gastrointestinais/tratamento farmacológico , Tumores do Estroma Gastrointestinal/tratamento farmacológico , Humanos , Transtornos da Pigmentação/patologiaRESUMO
BACKGROUND: Prostaglandin analogs reduce intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension; however, these medications may affect the ocular surface and elicit ocular discomfort when preserved with benzalkonium chloride (BAK). METHODS: This was an open-label, single-arm study conducted in Latin America from February 2012 to May 2013. Patients with open-angle glaucoma or ocular hypertension who were intolerant of latanoprost 0.005 % were transitioned to receive once-daily BAK-free travoprost 0.004 % containing polyquaternium-1 (Travatan® preserved with POLYQUAD® [PQ], Alcon Laboratories, Inc; Fort Worth, TX) for 12 weeks. Mean change in IOP from baseline (primary efficacy endpoint) and the percentage of patients who achieved a target IOP of ≤18 mmHg were evaluated at all on-therapy visits. Ocular hyperemia, patient preference, and self-projected adherence were assessed at week 12. Adverse events (AEs) were monitored throughout the study. RESULTS: All enrolled patients were included in the analysis (n = 191); the majority of patients (90.6 %, n = 173/191) completed the study. Mean (SD) patient age was 67.5 (11.3) years, and mean baseline IOP was 14.8 mmHg. Mean IOP was reduced by 0.94 mmHg at week 6 and by 1.09 mmHg at week 12 (P < 0.001 for both). A greater percentage of patients achieved a target IOP of ≤18 mmHg at week 6 (93.1 %; n = 163/175) and week 12 (93.3 %; n = 166/178) compared with baseline (89.5 %; n = 171/191). There was a 10.5 % increase in the percentage of patients with "none/trace" amounts of hyperemia. Most patients preferred the study medication (81.5 %; n = 141/173) and were confident that they would adhere to their preferred medication (90.8 %; n = 157/173). No serious AEs were reported, and eye irritation (3.7 %; n = 7/191) was the most common treatment-related AE. CONCLUSIONS: Transitioning from BAK-containing latanoprost 0.005 % to BAK-free travoprost 0.004 % preserved with PQ reduced IOP in patients with open-angle glaucoma or ocular hypertension who were intolerant of latanoprost. BAK-free travoprost 0.004 % is a viable alternative for patients who require switching their IOP-lowering medications because of tolerability issues. TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT01510145.
Assuntos
Anti-Hipertensivos/uso terapêutico , Compostos de Benzalcônio , Glaucoma de Ângulo Aberto/tratamento farmacológico , Pressão Intraocular/efeitos dos fármacos , Conservantes Farmacêuticos , Prostaglandinas F Sintéticas/uso terapêutico , Travoprost/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/efeitos adversos , Doenças da Túnica Conjuntiva/induzido quimicamente , Doenças da Córnea/induzido quimicamente , Substituição de Medicamentos , Feminino , Humanos , Hiperemia/induzido quimicamente , Latanoprosta , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/tratamento farmacológico , Tonometria Ocular , Travoprost/efeitos adversos , Adulto JovemRESUMO
PURPOSE: To evaluate the bulbar conjunctiva using impression cytology in patients submitted to oral isotretinoin treatment. METHODS: A prospective, cohort study was carried out in a referral ophthalmology practice at the Federal University of Paraíba and in the External Eye Disease Laboratory of the Federal University of São Paulo. Twenty-eight patients with acne vulgaris were selected. Impression cytology specimens collected from the temporal bulbar conjunctiva and the superior bulbar conjunctiva of both eyes before and after 3 months of oral isotretinoin treatment were assessed. The doses of isotretinoin varied from 0.35 to 0.88 mg . kg . d. RESULTS: The percentage of patients in whom impression cytology results were normal was significantly lower during oral isotretinoin treatment compared to the pretreatment phase, decreasing from 75% to 43% in the temporal bulbar conjunctiva and from 100% to 82% in the superior bulbar conjunctiva. In both regions, the parameters most affected were cell-to-cell contact, nucleus-to-cytoplasm ratio, and goblet cell density. CONCLUSION: Oral isotretinoin for the treatment of acne induces alterations in the conjunctival epithelium of a significant percentage of patients treated with the drug. These alterations are seen both in the exposed conjunctiva (temporal bulbar region) and in the unexposed conjunctiva (superior bulbar region).