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Adverse systemic effects from pledgets of topical ocular phenylephrine 10%
Frederick W Fraunfelder1, Frederick T Fraunfelder, Bree Jensvold
1Casey Eye Institute, Oregon Health Sciences University, Portland 097201, USA. fraunfer@ohsu.edu
American Journal of Ophthalmology
|October 18, 2002
Summary
Topical ocular phenylephrine 10% in pledget form caused severe systemic reactions in 11 patients. This application method is discouraged for ophthalmic surgery due to risks like hypertension and cardiac events.
Area of Science:
- Ophthalmology
- Pharmacology
- Clinical Medicine
Background:
- Phenylephrine is a vasoconstrictor used in ophthalmic procedures.
- The 10% concentration is potent and can be absorbed systemically.
- Pledget application may increase the risk of systemic absorption.
Purpose of the Study:
- To report adverse systemic reactions associated with topical ocular phenylephrine 10% in pledget form.
- To discourage the use of phenylephrine 10% pledgets for ophthalmic hemostasis.
- To highlight the potential dangers of this specific drug delivery method.
Main Methods:
- Observational case series.
- Review of literature and spontaneous reporting systems (FDA, National Registry of Drug-Induced Ocular Side Effects).
- Analysis of 11 cases detailing patient demographics, exposure, and systemic reactions.
Main Results:
- Eleven cases of adverse systemic reactions were identified.
- Reactions occurred after single exposure to phenylephrine 10% pledgets, often within minutes.
- Reported reactions included severe hypertension, pulmonary edema, cardiac arrhythmia, cardiac arrest, and subarachnoid hemorrhage.
Conclusions:
- Ophthalmologists should avoid using phenylephrine 10% in pledget form.
- This method is contraindicated in ophthalmic surgery.
- Alternative methods for hemostasis should be considered, especially when patients are on other medications.