Acute Systemic Hypertension
Atter Topical Ocular Phenylephrine : A Case Report
Arporn Prabriputaloong, M.D.
Prawit Sajjapong,
M.D.
Department
of Ophthalmology, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University,
Khon Kaen 40002, Thailand
Excerpt
from the article
Phenylephrine hydrochloride is
a commonly used mydriatic agent. It is generally considered safe except in patients with
angle closure glaucoma because of the possibility of precipitating acute attack. Serious
systemic complications from its topical used are rare. However, acute episodes of systemic
hypertension fol lowing the topical ocular application of 10% phenylephrine hydrochloride
have been documented in the literatures. This paper also presents a case of acute sys
temic hypertension possibly associated with conjunctival instillation of 10% phenylephrine
hydrochloride.
CASE
REPORT
A
58-year-old man was admitted to Srinagarind Hospital for cataract extraction
in his left eye. He was healthy and had no known cardiovascular or any other
systemic diseases.
On admission
his blood pressure was 140/90 mmHg. His pulse rate was 68 per minute and
regular. The temperature was 36.50C. His general physical
examinations were normal. Ocular examinations with slit lamp biomicroscopy
revealed no abnormalities except dense cataract in both eyes. Fundoscopic
examinations with indirect ophthalmoscope were also normal. Intraocular
pressure was 12 mmHg in each eye. The laboratory investigations included
a complete blood count, urine analysis and chest X-ray were within normal
limits.
n the day of operation,
the operated eye was dilated with alternately instillation of tropicamide
(mydriacyl) 1% and phenylephrine hydrochloride 10% eye drops, one drop each
every five minutes for six applications altogether. About half an hour after
the last drop, the pupil was not well dilated. Both kinds of eye drops were
repeatedly applied in the same manner, 2 drops of each kind, resulting in
full dilated pupil. The patient underwent extracapsular cataract extraction
with posterior chamber intraocular lens implantation without any complication.
Balanced salt solution with diluted adrenalin (0.5 ml of adrenalin 1:1,000
in BSS 500 ml) was used as the intraocular irrigating solution.
As soon
as the patient went back to the ward, he complained of moderately headache.
The blood presure was recorded as 180/100 mmHg. His pulse rate was 60 per
minute. The respiratory rate was 20 per minute and the tem perature was
36.20C. He was treated with oral paracetamol 1 gram but the headache
was not relieved. About one hour later, he developed severe headache, nausea
and vomiting. His blood pressure rose to 200/120 mmHg. Antihypertensive
drug (sublingual nifedipine 10 mg) was given. Within twenty minutes, his
blood pressure dropped to 180/100 mmHg and gradually to 130/90 mmHg twenty
minutes later. The headache was gradually resolved.
Thai J Ophthalmol 1990; 4(1);
17 |
