Therapeutics News

The three Food and Drug Administration-approved erectile dysfunction (ED) medications, sildenafil (Viagra, Pfizer), tadalafil (Cialis, Eli Lilly) and vardenafil (Levitra, Bayer Pharmaceuticals/GlaxoSmithKline), have each been implicated in a number of different ocular changes, some temporary and benign and others permanent and visually devastating. The most recent debate has been whether these ED drugs cause nonarteritic anterior ischemic optic neuropathy (NAION).

Many organisms have the ability to infect human tissue. Of these organisms, some have developed a propensity for tissues of the eye. Bacteria, viruses and, less often, fungi result in mild to severe infections that have the ability to affect the adnexae and superficial ocular surface as well as tissue of the posterior pole.

Benign eyelid myokymia (BEM), as the name implies, is a benign and idiopathic condition in which, typically, the orbicularis oculi muscle of one of the lower lids (occasionally, the upper eyelid may also be affected) twitches or displays spontaneous and fine fascicular contractions.

J. James Thimons

Ernie Bowling

The newer-generation fluoroquinolones Zymar (gatifloxacin, Allergan) and Vigamox (moxifloxacin, Alcon) are well regarded for their ability to combat ocular infections such as infectious keratitis.

Since their approval by the Food and Drug Administration in 2003, fourth-generation fluoroquinolones have quickly assumed a prominent place in the optometric armamentarium. Especially valuable for their broad-spectrum coverage against gram-positive and gram-negative organisms, these agents have become the anti-infective of choice for many optometrists.

Joseph P. Shovlin, OD, FAAO: To provide a response consistent with the question, I’ll assume that the patient has a presumed microbial event rather than a sterile ulcer like that found in an indolent (sterile) shield ulcer from vernal disease or contact lens peripheral ulcer.

Andrew S. Gurwood, OD, FAAO, is an associate professor of clinical sciences and an attending optometric physician at The Eye Institute of the Pennsylvania College of Optometry. He is also a member of the clinical staff in the Department of Ophthalmology at Albert Einstein Medical Center in Philadelphia. Dr. Gurwood can be reached at the Pennsylvania College of Optometry, 1200 West Godfrey Ave., Philadelphia, PA 19141; (215) 276-6134; fax: (215) 276-1329; e-mail: Agurwood@pco.edu. Dr. Gurwood has no direct financial interest in the products mentioned in this article, nor is he a paid consultant for any companies mentioned.

Paul M. Karpecki, OD, FAAO: The oral medication I prescribe most often is oral doxycycline 100 mg twice daily. This medication is interesting in that its benefits are not its antibiotic properties (in fact there is broad resistance to this agent), but rather its anti-inflammatory capabilities. Studies have suggested that doxycycline’s benefits stem from the ability to accumulate in oil glands, to regulate staphylococcal enzymes such as lipase and its anti-inflammatory nature. This combination makes it a very effective drug for conditions associated with inflammation surrounding oil glands. Such pathologies include meibomian gland dysfunction, internal hordeolum, blepharitis and acne rosacea (sebaceous glands), as examples. Certainly, any tetracycline medication should be avoided in pregnant or nursing women as well as children. Patients should also be informed of the risk of phototoxicity, gastritis and the potential for this medication to chelate out in the presence of dairy products or antacids, and patients should be followed for the rare risk of pseudotumor cerebri.