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Botulinum toxin complications and management
Published in Michael Parker, Charlie James, Fundamentals for Cosmetic Practice, 2022
There is some evidence that apraclonidine 0.5% eye drops may be beneficial in reducing the severity and length of ptosis due to botulinum toxin treatment. Apraclonidine is an alpha-adrenergic receptor antagonist frequently used in the treatment of glaucoma. It is inadvisable for you to start this treatment in the community without a prior specialist ophthalmology review. Should you cause a ptosis in your patient then best practice would dictate for you to arrange for an urgent ophthalmology assessment for further management. As with all complications, write a letter to the accepting doctor outlining the initial treatment and steps you have taken to rectify this complication.
Apraclonidine
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
Apraclonidine is a clonidine derivative with selective α2-adrenergic agonistic activity. Upon ocular administration, apraclonidine enhances aqueous humor uveoscleral outflow and decreases aqueous production by vasoconstriction, thereby decreasing intraocular pressure (IOP). Apraclonidine is used for prevention or reduction of intraoperative and postoperative increases in intraocular pressure before and after ocular laser surgery. It has also application as a short-term adjunctive therapy in patients with open-angle glaucoma who are on maximally tolerated medical therapy requiring additional IOP reduction. In pharmaceutical products, apraclonidine is employed as apraclonidine hydrochloride (CAS number 73218-79-8, EC number not available, molecular formula C9H11Cl3N4) (1).
Neuro-ophthalmology
Published in Mostafa Khalil, Omar Kouli, The Duke Elder Exam of Ophthalmology, 2019
Topical apraclonidine (0.5% or 1%) Used to confirm a Horner's pupil.Apraclonidine is an alpha-2 and alpha-1 adrenergic agonist.Causes pupillary dilation in the Horner's pupil due to denervation supersensitivity.
Ocular Surface Disease and Anti-Glaucoma Medications: Various features, Diagnosis, and Management Guidelines
Published in Seminars in Ophthalmology, 2023
Sowmya Andole, Sirisha Senthil
Topical beta-blockers can cause medication-induced adverse effects on the eyelids and conjunctiva. Apraclonidine can cause contact dermatitis of the periocular area and eyelids.7 Contact dermatitis occurs due to a portion of the drug binds to the dermal protein to form a complex hapten, which sensitizes the individual. When the drug is re-instilled it induces a delayed hypersensitivity reaction, which is the cause for allergy. Apraclonidine can also cause ectropion of the eyelid which progressed to cicatricial ectropion in some patients.20,21 In individuals with preexisting lid laxity, tissue edema due to allergy can worsen the preexisting problem resulting in ectropion. Chronic allergy with skin excoriation can also cause fibrotic changes and tissue shortening that can lead to ectropion.
An overview of the pharmacotherapeutics for dystonia: advances over the past decade
Published in Expert Opinion on Pharmacotherapy, 2022
O. Abu-hadid, J. Jimenez-Shahed
Apraclonidine is a less lipophilic version of clonidine with the same mechanism of action and is administered as an eye drop. Apraclonidine is shown to help reduce adverse events, such as ptosis and Horner syndrome, due to botulinum toxin injections for BS [105]. The presumed mechanism is activation of the superior tarsal muscle. A prospective observational study used apraclonidine in seven patients with BS who experienced early wearing off with botulinumtoxin [106]. Patients were not blinded and all received apraclonidine, however, the video raters were blinded [106]. All the patients noted subjective improvement, and there was a significant difference in rating (p < 0.025) by the blinded raters before (3.4/4.0) and after (2.3/4.0) administration, with a higher rating indicating more severe blepharospasm [106].
Selective Laser Trabeculoplasty for Steroid-Induced Ocular Hypertension following Endothelial Keratoplasty
Published in Current Eye Research, 2022
Max Davidson, Eran Berkowitz, Harry Roberts, Ahmed Wanas, James Myerscough
Pilocarpine 2% and apraclonidine 1% were instilled into the treated eye 15–30 minutes before the procedure. A frequency doubled, Q-switched Nd:YAG laser was used, emitting a wavelength of 532 nm, coupled to a slit lamp delivery system (SeLecTor Deux, Lightmed corporation, CA, USA). It operates with a single pulse of 3 ns duration and a spot size of 400 µm. The initial laser energy was set at 0.5 mJ and a single laser pulse was delivered at the 12 o’clock position. If no bubble was observed, the energy was increased by 0.1 mJ increments until bubble formation. This energy level is considered the threshold energy. Recommended energy settings for conventional treatment are levels 0.1 mJ less than the threshold energy. A cut-off energy was set at 1.2 mJ even when no obvious reaction was observed. SLT was delivered to 360° of the trabecular meshwork. 100 non-overlapping shots (25 per quadrant) were used, using a gonioscopy lens.