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Systemic reaction to subconjunctival phenylephrine

S A Miller, W F Mieler

    Canadian Journal of Ophthalmology. Journal Canadien D'Ophtalmologie
    |October 1, 1978
    PubMed
    Summary
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    Subconjunctival injection of phenylephrine, cocaine, and atropine caused a severe blood pressure spike and subsequent complications. These effects resolved spontaneously, highlighting the risks of ophthalmic phenylephrine.

    Area of Science:

    • Ophthalmology
    • Cardiology
    • Pharmacology

    Background:

    • Subconjunctival injections are used in ophthalmic procedures.
    • Phenylephrine is a commonly used vasoconstrictor in ophthalmology.
    • Systemic absorption and potential adverse effects of ophthalmic agents require consideration.

    Observation:

    • A patient experienced a significant hypertensive crisis (220/180 mmHg) following subconjunctival injection.
    • The hypertensive episode was followed by hypotension, pulmonary edema, and subendocardial ischemia.
    • All adverse events resolved spontaneously within a 12-hour period.

    Findings:

    • Ophthalmic phenylephrine administration can lead to severe, albeit transient, systemic cardiovascular complications.
    • The combination of phenylephrine, cocaine, and atropine may potentiate adverse systemic effects.

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  • The case underscores the potential for significant blood pressure fluctuations after ocular drug delivery.

    • Implications:

    • Clinicians should exercise caution when administering phenylephrine, especially in patients with pre-existing cardiovascular conditions.
    • Monitoring blood pressure and cardiovascular status post-injection may be warranted.
    • This case highlights the importance of understanding the systemic pharmacodynamics of topical ophthalmic agents.