W E L C O M E This is a new bulletin prepared for General Practitioners, Optometrists and Hospital Staff. We plan about 6 bulletins per year. We aim to update you on ‘new’ developments in ophthalmology, remind you of important ophthalmic conditions and keep you informed of ‘comings and goings’ in the Ophthalmology Department. Please e-mail us with any comments or requests. All bulletins will be available at eyenz.com - the eye department website. This also has other useful eye information and patient education files. This first bulletin looks at commonly used systemic medication and their ocular side effects. C L I N I C A L N E W S D r u g I n d u c e d O c u l a r T o x i c i t y Hydroxychloroquine Used in the treatment of certain rheumatological disorders. The two main potential side effects are maculopathy (irreversible) and corneal deposits. Hydroxychloroquine, however, is much safer than Chloroquine and side effects are unlikely in first ten years of use. Recommendations: Baseline ophthalmic assessment on commencing drug, then after five years of treatment, a yearly eye examination. Quinine Commonly used for relief of nocturnal muscle cramps. Acute poisoning causes blindness but visual loss can occur on an idiosyncratic basis in patients taking a normal dose. Amiodarone Two per cent of patients can develop bilateral swollen discs with reduction in vision. Some improve on cessation, some do not. Advise all patients on Amiodarone about possible visual loss – there is no role for screening. Corneal deposits are universal, asymptomatic and reversible. Thioridazine (Melleril)
Can cause reduced vision and poor dark adaptation if used in high doses.
Chlorpromazine (Largactil)
Can cause visually insignificant lens changes.
Tamoxifen Ocular complications (retinal crystals) are uncommon. Steroids Both systemic and topical can cause cataract and glaucoma. The exact relationship among total dose, weekly dose and duration of administration of steroids and cataract formation is unclear. Topical or inhaled steroids can cause glaucoma – especially in those with a family history of glaucoma or a worsening of glaucoma in those who already have it. There are no evidence- based recommendations, however, it may be prudent to ask patients on steroids to have a 1-2 yearly eye check. Vigabatrin (Sabril) This anticonvulsant can cause asymptomatic and irreversible peripheral visual field defects. It is not clear whether the defect may continue to worsen with increased duration. There is a concentric constriction of the field – worse nasally than temporally. Recommendation: visual field test at baseline and 6 monthly thereafter. The risks / benefits of using this drug need to be carefully assessed. Children require special consideration.
EYE DEPT NEWS
We welcome Jo Kennaway, our new orthoptist, who has joined us from Auckland. Originally from Ireland, Jo was trained in Britain, has worked at Moorfields Eye Hospital, London then Saudi Arabia, Auckland and now Nelson! Jo runs the Paediatric Ophthalmology Photo Screening Service, manages children and adults with strabismus and is a great asset to us. Finally a summary of how we’re dealing with the waiting list, as of 1 June, 2003. The Good News: Patients seen since July 2002: surgery 432; outpatients – 1454 FSA, 3990 FU. Outpatients remains an area of unmet need despite us seeing 40% more patients than the contract allows. The Bad News: Still waiting to be seen: surgical 252; outpatients 727 (155 have appointments, 100 semi-urgents have no appointment, 424 routine have no appointment). The waiting time for routine referrals is currently estimated to be 3 years!!
POST-OPERATIVE INSTRUCTIONS FOR SHOULDER ARTHROSCOPY WITH CAPSULAR RELEASE Mercy Health System: Sports Medicine Service A. Day of Surgery: Diet: Begin with liquids and light foods (jello, soup, etc) Progress to your normal diet if you are not nauseated. Medication: Strong pain medication has been prescribed. Use as directed. Do not combine with alcohol. Be careful as yo
G6PD Deficiency capable of producing the G6PD enzyme, resulting is an important element (enzyme) in the glucose in more severe symptoms. Females, on the other oxidation (oxygen utilization) process of red blood hand, inherit two X chromosomes, one from each cells (RBCs) and for maintaining their normal life parent. A mutation in one copy is compensated for span. G6PD deficiency is an inh
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