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)

Botulinum toxin has become the initial treatment of choice for the management of essential blepharospasm, hemifacial spasm and other craniocervical dystonias. Numerous studies have confirmed a 90% to 95% response rate. Although a number of common side effects have been reported, the occurrence and incidence of rare local complications remains poorly understood. More importantly, the acute and chronic distant effects of botulinum toxin have not been clearly elucidated. A better understanding of such effects is essential if clinicians are to appropriately advise patients on the use of this therapeutic modality. This article is based on the Duke University experience in the management of over 500 patients with craniocervical spasm disorders, combined with a review of the published literature. These disorders include essential blepharospasm, oromandibular dystonia, hemifacial spasm, and torticollis. The incidence of side effects following more than 6000 treatments with botulinum toxin is presented. Pertinent research relating to the causes of these complications is also reviewed. The most common complications of treatment with botulinum toxin are related to acute local effects resulting from chemodenervation. The most important clinical effect in this group is weakening of the levator muscle resulting in ptosis, and the corneal consequences of lagophthalmos. The latter includes exposure keratitis, dry eyes, blurred vision, and hypersecretion epiphora. Less common local effects include facial numbness, diplopia, and ectropion. Some distant effects are being observed with increasing frequency. These include pruritus, dysphagia, nausea, and a flu-like syndrome. Most significant, however, are the rare reports of generalized weakness and the documentation of EMG abnormalities distant to the site of toxin injection. This has been seen with injections for both blepharospasm and torticollis. Until further studies on the long-term distant complications of botulinum toxin are available, it is recommended that patients receive as few life-time doses of toxin as possible, consistent with adequate management of their spasms. The practice of reinjecting patients routinely every three months, or at the first return of mild spasms should be discouraged.
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PMID:Botulinum-A toxin in the treatment of craniocervical muscle spasms: short- and long-term, local and systemic effects. 882 30

A double-blind study was performed on 212 consecutive patients (58 men, 154 women) with essential blepharospasm, who received one injection of Botox and one injection of Dysport in two separate treatment sessions (at the first session the patients randomly received one of the drugs, at the second the other drug was given. The patients' mean age was 66.4 years +/- 8.14 (range 39-86 years). The average dose of Botox per treatment was 45.4 IU +/- 13.3 (range 25-85 IU) and of Dysport 182.1 IU +/- 55.1 (range 100-340 IU). We used an empirical ratio Botox:Dysport of 1:4 (IU) in order to ensure equal doses. All patients had received botulinum toxin injections prior to the present study (mean 15.3 injections +/- 9.4; range 1-43 injections). The effect of Botox lasted 7.98 weeks +/- 3.8 (range 0-16 weeks), while the effect of Dysport lasted 8.03 weeks +/- 4.6 (range 0-22 weeks). Side effects (ptosis, tearing, blurred vision, double vision, hematoma, foreign body sensation) were observed with Botox in 36 of 212 (17.0%) of the treatment sessions and with Dysport in 51 of 212 sessions (24.1%). Ptosis was observed with Botox in 3 cases (1.4%) and with Dysport in 14 cases (6.6%). There was no statistically significant difference in the duration of the treatment effect between the two preparations (P = 0.42). The total number of side effects was lower with Botox than with Dysport; the significance of the difference was moderate (P < 0.05). However, the rate of occurrence of ptosis was significantly lower with Botox (P < 0.01). The bioequivalence, which varies between 1:3 and 1:6 (Botox:Dysport) in the literature, was found to be 1:4 in this study.
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PMID:Comparison of two botulinum-toxin preparations in the treatment of essential blepharospasm. 914 85

Two cases of craniopharyngioma with delayed diagnosis are presented. Patient 1 had mild visual loss that initially had been attributed to pigment epithelial detachment in the macular area. Patient 2 had blurred vision in the left eye, although visual acuity was 10/10 at both eyes. She had a history of a posttraumatic neurosurgical procedure and was treated for blepharospasm. Both patients had initially negative CT imaging. Visual field defects suggested a chiasmal lesion and incited to additional neuroradiological investigation. Magnetic resonance imaging revealed a craniopharyngioma in both cases.
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PMID:Pitfalls in the diagnosis of craniopharyngioma: 2 case reports. 1170 42

Polyamphoteric washing solutions (PWS) have been used for several years, mainly in industries, for cases of chemical ocular or cutaneous splashes by acid or alkali. We collected 37 cases reporting the use of PWS for ocular and cutaneous chemical splashes from several centres. Among the 37 cases, 55.26% resulted from occupational exposure. Among ocular exposures, initial clinical symptoms included pain (20 cases), blepharospasm (4 cases), hyperaemia (15 cases), palpebral oedema (2 cases) and blurred vision (7 cases). Among cutaneous exposures, 2 injuries were classified as deep, and 11 as superficial. Mean (SD) pain (VAS) before PWS was 6,29 +/- 2,74; mean (SD) pain after PWS was 1,47 +/- 1,73. Early application of PWS to the eye or skin reduces the intensity of pain that is associated with chemical damage. Early application of amphoteric solution appears to reduce the incidence of sequelae, provided its pre-hospital and hospital use is early. However, further studies are needed.
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PMID:??? 2998 84