Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0344232 (blurred vision)
 2,072 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Since its approval by the Food and Drug Administration (FDA), timolol has been widely used for the treatment of open-angle glaucoma. Contrary to the clinical trials before FDA approval, many reports of possible ocular and systemic side effects have now appeared. Cardiovascular, respiratory, and gastrointestinal systemic effects occur relatively often and are attributable to beta-adrenergic antagonism, but central nervous system (CNS) effects are not so explainable. The most frequent ocular side effects are instillation pain and blurred vision, often requiring discontinuation of timolol. Superficial punctate keratitis and associated reduced corneal sensitivity have been reported and pose a risk for affected contact lens wearers. The incidence of side effects in two prospective studies was about 20%, with some 40% of those having to discontinue timolol. Of optometric interest are reports that timolol increases the electro-oculogram (EOG) ratio (Arden Index), and that it may be used to lower intraocular pressure in acute angle closure when pilocarpine alone is unsuccessful.
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PMID:Clinical implications of reported timolol-induced side effects. 612 2

A patient with primary open-angle glaucoma (POAG) underwent a trabeculectomy according to Watson's technique. Postoperative intraocular pressure (IOP) ranged from 8 to 11 mm Hg. However, repeat slit lamp evaluation revealed the absence of bleb formation. Two months post-filtration surgery the patient developed the sudden onset of nausea, vomiting, supraorbital pain, and blurred vision. The IOP was 46 mm Hg and gonioscopy revealed a hyaline membrane covering a cyclodialysis cleft. A Nd:YAG laser was used to reopen the cleft, with normalization of IOP.
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PMID:Reopening cyclodialysis cleft with Nd:YAG laser following trabeculectomy. 654 22

Complications from mydriatic and cycloplegic drugs are rare compared with their extensive use. Adverse effects are often related to dosage or other factors. The ocular complications include increased intraocular pressure, pigmentation of the conjunctiva and cornea, pigment in the anterior chamber, lacrimal duct blockage, macular edema, corneal endothelium damage, hyperemia, allergy, discomfort, and blurred vision. The systemic complications are those common to sympathomimetic and parasympatholytic drugs and include tachycardia, hypertension, headache, faintness. pallor, trembling, excessive sweating, palpitations, arrhythmias, confusion, hallucinations, drowsiness, ataxia, flushed skin, high fever, dysarthria, thirst, dry mouth, convulsions, disorientation, nervousness, coma, and death. An understanding of all possible side effects is of paramount importance to those using these drugs in the treatment of anticholinesterase poisoning. This review is intended as a ready reference to the adverse effects of mydriatic and cycloplegic drugs.
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PMID:Mydriatic and cycloplegic drugs: a review of ocular and systemic complications. 703 29

A 32-year-old man with pigmentary dispersion syndrome had blurred vision and halos after strenuous exercise, associated with a release of pigment into the anterior chamber and increased intraocular pressure (IOP). Additionally, he had typical symptoms after emotional stress or exposure to dim illumination, and had a high IOP without angle closure during a darkroom provocative test. The exercise-induced symptoms and the increase of IOP were prevented by the use of pilocarpine 0.5% drops immediately before exercise.
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PMID:Exercise-induced increase of intraocular pressure in the pigmentary dispersion syndrome. 736 24

In a 12-week double-masked trial we compared the ocular hypotensive effect of 0.25% timolol in Gelrite administered once daily (TG) to that of 0.25% timolol solution administered twice daily (TS). A second objective was to compare the tolerability and the safety of these treatments. Timolol in Gelrite is a new topical formulation of timolol in an anionic heteropolysaccharide gellan gum. A total of 156 patients entered the study after an appropriate wash-out. The medication schedule included one drop of test drug in each eye at 9 a.m. (active drug for both groups) and 9 p.m. (placebo for the TG group, active drug for the TS group). At trough, the mean decrease from baseline intraocular pressure (after appropriate wash-out) ranged from 5.7 to 6.3 mmHg for the TG group and from 5.9 to 6.2 mmHg for the TS group. The difference between the treatment group means ranged from -0.4 to 0.4 mmHg. At peak, the mean decrease from baseline IOP ranged from 5.3 to 6.2 mmHg for TG group and from 5.1 to 6.1 mmHg for the TS group. The difference between the treatment group means ranged from -0.7 to 0.4 mmHg. The results of this study support the hypothesis of a comparable hypotensive effect at peak and trough of 0.25% timolol in Gelrite q.d. to 0.25% timolol solution b.i.d. Furthermore, timolol in Gelrite has an acceptable tolerability profile. The incidence of blurred vision was higher in the Gelrite group, but this different was not statistically significant. The incidence of foreign body sensation was significantly higher in the Gelrite group (P < 0.022).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Multicenter double-blind study with 0.25% timolol in Gelrite (TG) once daily vs. 0.25% timolol solution (TS) twice daily. German Study Group]. 754 45

Exposure to anticholinesterase pesticides has been associated with the development of ocular toxicity in humans and animals, ranging from blurred vision to degeneration of the optic nerve. Based on the concern for human safety, the US Environmental Protection Agency has recently required additional studies for this class of compounds, focusing on biochemical, functional and histopathological evaluation of the ocular system. This study was designed to determine the effects on the eye of ethyl parathion, a highly toxic organophosphate, when administered orally to 30 beagle dogs (five of each sex per group) at doses of 2.4, 7.9 or 794 micrograms kg-1day-1 for 6 months. Control animals received corn oil. Routine ophthalmoscopic and slit lamp examinations, refraction and intraocular pressure determinations and electroretinograms were performed as functional assessments at various intervals over the study. Plasma and erythrocyte cholinesterase were determined at weeks 1, 6, 14, 20 and 26, while brain, retinal and ocular muscle cholinesterase were measured at week 26 only. Histopathological examination of the retina, optic nerve, ocular muscle and ciliary body was conducted at termination. Plasma and erythrocyte cholinesterase was markedly depressed at 7.9 and 794 micrograms kg-1day-1 as early as week 1. Retinal cholinesterase was decreased (37-55%) from control values in the 794 micrograms kg-1day-1 group only. Ocular muscle cholinesterase was comparable in treated and control groups at termination. No functional impairment of the eye was noted over the 6-month study.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Assessment of ocular toxicity in dogs during 6 months' exposure to a potent organophosphate. 802 10

The effect on the intraocular pressure (IOP) of 0.5% timolol solution given twice daily was compared to 0.5% timolol in gel-forming solution given once daily. Patients (n = 223) having an IOP of above 22 mmHg were recruited from 16 eye specialist centres in Scandinavia and Finland. The patients were randomized to two treatment groups, timolol solution treatment and timolol in gel-forming solution treatment. Eyes with and without pseudoexfoliation were included. The patients were stratified regarding the presence or not of pseudoexfoliation, to ensure appropriate distribution of this condition. No difference in intraocular pressure reducing effect was registered for the two groups. The pressure reducing effect of the two modes of treatment was not affected by the presence or not of pseudoexfoliation. The study also included registration of local and systemic signs and symptoms possibly related to the study medications. Blurring of vision occurred more often in patients given 0.5% timolol in gel-forming solution compared to timolol solution. The heart rate decreased statistically significantly in patients given timolol solution, but not in patients given timolol in gel-forming solution. This study suggests that treatment with 0.5% timolol in gel-forming solution once a day may be equally as good as 0.5% timolol solution given twice a day in patients with glaucoma both with and without pseudoexfoliation.
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PMID:The intraocular pressure lowering effect of timolol in gel-forming solution. 873 82

Acute angle-closure glaucoma is a rare complication of surgery. We experienced a case of postoperative acute glaucoma after total hip replacement under general anesthesia. A 49-year-old female without signs or symptoms of glaucoma was premedicated with the intramuscular administration of secobarbital, atropine and ranitidine. Following rapid induction with thiopental and vecuronium, anesthesia was maintained with N2O-O2-sevoflurane. PGE1 was administered intravenously for induced hypotension during the surgery. Hemorrhagic shock with a systolic blood pressure of 60 mmHg continued for 15 min during the surgery. Large amounts of fluid and ephedrine were required for treating this hypotensive episode. Vecuronium was reversed by bolus injection of neostigmine and atropine at the end of surgery. Soon after recovery from anesthesia, she complained of pain and blurred vision in her both eyes. The consulting ophthalmologist made a diagnosis of acute glaucoma due to high intraocular pressure (IOP). Treatment with glycerol and pilocarpine had no effect on the elevated IOP. The laser iridotomy performed on her at 5th and 7th post-operative days improved her vision completely. The post-operative glaucoma may cause serious permanent loss of vision. An early diagnosis of this post-operative complication and its treatment with drugs and surgery should be emphasized.
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PMID:[Acute angle-closure glaucoma after total hip replacement surgery]. 922 89

We compared the efficacy of timolol maleate ophthalmic gel-forming solution 0.5% QD with that of levobunolol hydrochloride 0.5% BID, as measured by change in intraocular pressure (IOP), effect on heart rate, and ocular tolerability. The study had a positive-controlled, double-masked, randomized, multicenter, 12-week, two-period (6 weeks each), crossover design. One hundred fifty-two patients with open-angle glaucoma or ocular hypertension were randomized to receive either timolol maleate gel-forming solution QD or levobunolol BID for 6 weeks, followed by a crossover to the alternate treatment. IOP and heart rate were measured at morning trough and peak during weeks 3, 6, 9, and 12. Timolol maleate gel-forming solution QD was comparable to levobunolol BID in reducing IOP at peak and trough. Although the effects on peak heart rate were similar between the two medications, the effect on trough heart rate of timolol maleate gel-forming solution QD was significantly less than that of levobunolol BID (P = 0.001). The incidence of ocular burning and stinging was comparable between the two treatments. Patients experienced significantly more blurred vision when using timolol maleate gel-forming solution than when using levobunolol (P = 0.013). Overall, more patients experienced at least one adverse event when using timolol maleate gel-forming solution. Timolol maleate gel-forming solution QD is as efficacious in reducing IOP as levobunolol BID.
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PMID:Efficacy and tolerability of 0.5% timolol maleate ophthalmic gel-forming solution QD compared with 0.5% levobunolol hydrochloride BID in patients with open-angle glaucoma or ocular hypertension. 991 10

There was a time gap of over 40 years between the demonstrated oral effectiveness of acetazolamide in lowering the intraocular pressure (IOP) of glaucoma patients and the introduction of a topical carbonic anhydrase (CA) inhibitor. This is due to the fact that CA-II, the isoenzyme which most likely plays an important role in the production of aqueous humor in humans, must be essentially inhibited by 100% to elicit a pharmacological response. The lack of success with earlier attempts to obtain a topical agent stems from an inability to attain and maintain a sufficiently high intraocular concentration of drug to achieve the required inhibition of CA. Dorzolamide and brinzolamide are two topical CA inhibitors which are currently available to treat ocular hypertension and/or glaucoma. Dorzolamide is a very potent inhibitor of CA-II and its site of action is local within the eye. Like oral CA inhibitors, topically applied dorzolamide lowers IOP by decreasing the production of aqueous humor. The drug is used in monotherapy as a 2% solution administered three times daily. Its ocular hypotensive effect is comparable to that of timolol at peak but is somewhat less at trough. The IOP lowering effect of timolol is enhanced by the twice daily administration of 2% dorzolamide either concomitantly or in combination. Topically applied dorzolamide is generally well tolerated and had a low drop-out rate in clinical studies. The most frequent ocular adverse experience is burning and/or stinging. Corneal and lenticular problems have generally not been encountered with long-term therapy with dorzolamide. Topically applied dorzolamide penetrates directly to the posterior segment of the eye and its presence is consistent with the initial report that dorzolamide increases retinal blood flow velocity in patients with normal tension glaucoma. The most frequent systemic adverse experience is a transient bitter taste. Biochemical changes indicative of the systemic inhibition of CA have not been observed in monotherapy studies lasting up to 2 years. This is in harmony with the inability of dorzolamide at steady-state to saturate CA in the red blood cell and the failure to detect its presence in plasma. A 1% suspension of brinzolamide is comparable to 2% dorzolamide in lowering IOP, both drugs being administered three times daily. Although brinzolamide has a lower incidence of burning/ stinging, it elicits more blurred vision.
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PMID:Pharmacological and ocular hypotensive properties of topical carbonic anhydrase inhibitors. 1061 82


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