BLOG: Hemorrhoid ointment used as anti-aging cream can dilate the pupil, presenting a diagnostic dilemma

Read more oculoplastics blog posts from Mark R. Levine, MD

The business of facial rejuvenation is bigger than ever with promises of reducing the appearance of fine lines and wrinkles. Because these nonprescription wrinkle creams are not classified as a drug, they are not required to undergo scientific scrutiny to prove their effectiveness.

How creams work to reduce fine lines and wrinkles varies. Some work on top of the skin by hydrating and exfoliating, while others work under the skin as a collagen-stimulating cream. Many of these creams have antioxidants such as vitamin A, C and E and beta carotene. These neutralize free radicals that breakdown skin and cause wrinkles. Other antioxidants are tea and grapeseed extract.

Creams that contain peptides stimulate the body's natural production of collagen. These products plump up the skin, reducing lines and wrinkles.

Let us face it, these may be temporizing measures to avoid fillers, Botox and surgery, which may not be affordable to many. Moreover, patients who abuse their skin by sunbathing and smoking are hardly likely to age well and benefit from these creams.

Other people can seek help from home remedies (alternative medicine) to treat wrinkles and puffs. Hemorrhoidal ointments have been one of these home remedies, which, in their older formulations, contained yeast cell derivatives and shark liver oil. The more up-to-date formulation contains petroleum, glycerin and phenylephrine 0.25%. The phenylephrine is an alpha 1-adrenergic receptor agonist that is a vasoconstrictor of the arteriole bed which reduces capillary blood flow to tissues. With the pupil, it acts mainly on the alpha-adrenergic receptors on the iris smooth muscle and dilates the pupil.

The importance of this is most obvious and should remind all of us to take the time to question the patient carefully who comes in with a dilated pupil with blurred vision to avoid unnecessary imaging.