Reversible anisocoria due to inadvertent ocular exposure to topical anticholinergic treatment for primary axillary hyperhidrosis

Pashaei-Marandi, Aryan; Assam, Jed H.; Arnold, Anthony C.; Lee, Andrew G.; Bonelli, Laura

doi:10.1016/j.jcjo.2019.04.009

Cited by 10 publications

(7 citation statements)

References 5 publications

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“…In glycopyrronium tosylate recipients, most cases of mydriasis were unilateral (23/31 events), while most cases of blurred vision were bilateral (11/16 events) [13]. There have also been case reports of reversible unilateral mydriasis in patients treated with topical anticholinergics (including glycopyrronium tosylate), likely resulting from accidental ocular exposure [19, 20]; clinicians should be aware of this potential benign etiology in patients presenting with mydriasis [20].…”

Section: What Is the Tolerability Profile Of Glycopyrronium Tosylate?mentioning

confidence: 99%

Topical Glycopyrronium Tosylate in Primary Axillary Hyperhidrosis: A Profile of Its Use

Lamb

2019

Clin Drug Investig

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Glycopyrronium tosylate (Qbrexza ™) is available as single-use, pre-moistened cloths and has been approved in the USA for the topical treatment of primary axillary hyperhidrosis in adults and children ≥ 9 years of age. Glycopyrronium tosylate is effective in reducing patient-reported severity of disease and gravimetrically measured sweat production in this patient population; improvements have been shown to be maintained throughout long-term treatment (up to 48 weeks). Glycopyrronium tosylate is generally well tolerated, with most adverse events being mild to moderate in severity. Glycopyrronium tosylate thus provides a self-administered, non-invasive alternative to topical antiperspirant therapy and clinic-based treatments in adults with primary axillary hyperhidrosis, and is the only alternative to topical antiperspirants specifically approved in children and adolescents ≥ 9 years of age. Adis evaluation of topical glycopyrronium tosylate in primary axillary hyperhidrosis First US-approved topical anticholinergic treatment for this indication; applied once daily with a single-use cloth Suitable for use in patients ≥ 9 years of age Effective in improving disease severity, sweat production and quality of life Generally well tolerated, with adverse events infrequently leading to treatment discontinuation Enhanced material for this Adis Drug Q&A can be found at https ://doi.org/10.6084/m9.figsh are.97892 84.

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Section: What Is the Tolerability Profile Of Glycopyrronium Tosylate?mentioning

confidence: 99%

Topical Glycopyrronium Tosylate in Primary Axillary Hyperhidrosis: A Profile of Its Use

Lamb

2019

Clin Drug Investig

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“…Accurate diagnosis by clinical history may assuage patient anxiety and avoid nondiagnostic imaging, which is both expensive and unnecessary (9,10,13,14). In the absence of clinical suspicion for an alternate etiology for mydriasis, radiologic imaging does not play a role in the evaluation of the patient with mydriasis suspected to be pharmacologic in nature.…”

Section: Discussionmentioning

confidence: 99%

Pharmacologic Mydriasis Secondary to Topical Glycopyrronium Tosylate Cloths: Clinical Characterization From a Multicenter Analysis

Kaufman¹,

Gulati²,

Pula³

et al. 2022

Journal of Neuro-Ophthalmology

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Background:Topical glycopyrronium tosylate (GT) is an anticholinergic medication for treatment of axillary hyperhidrosis. Pharmacologic mydriasis and anisocoria from topical GT has been reported and may be underrecognized. This study aims to clinically characterize patients presenting with pharmacologic mydriasis from exposure to this medication.Methods:This study is a retrospective observational case series. A multicenter chart review of 16 patients diagnosed with pharmacologic mydriasis secondary to topical GT was performed.Results:Eight patients (50.0%) were age 18 years and younger, and 14 patients (87.5%) were female. Unilateral mydriasis (anisocoria) occurred in 14 patients (87.5%). Fourteen patients (87.5%) did not initially volunteer topical GT as a “medication,” and the history of topical GT exposure needed to be elicited with further questioning. Hand hygiene details were known for 12 patients, and all reported that they did not wash their hands after GT application. Six patients (37.5%) were soft contact lens users. One patient had possible exposure through a family member's use of the medication. Ocular symptoms were common (blurry vision [11 patients, 68.8%] and eye dryness [7 patients, 43.8%]), but systemic anticholinergic symptoms were uncommon (such as constipation [1 patient, 6.3%] and urinary symptoms [3 patients, 18.8%]).Conclusions:Mydriasis associated with topical GT seems to be a consequence of local exposure rather than systemic toxicity. Because patients may not volunteer topical GT as a medication, eliciting a history of exposure often requires further specific questioning. Soft contact lens wear and poor postapplication hand hygiene seem to be associated with mydriasis in GT use.

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“…Secondary hyperhidrosis is the result of other causes such as malignancy, endocrine disorders or the side effects of some drugs or medications, whereas in primary hyperhidrosis, the nerves responsible for signaling the sweat glands become overactive [1,3]. Common treatments include the use of skin creams, systemic anticholinergic drugs, topical injection of botulinum toxin A, and even surgical procedures [1, 3,4]. Surgical procedures include local removal of axillary sweat glands as well as thoracoscopic blocking of certain branches of the thoracic sympathetic chain [5].…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcomes of Uniportal Versus Multiportal Endoscopic Thoracic Sympathectomy in Patients With Severe Palmar and Axillary Hyperhidrosis

ASLANER¹

2022

Acta Medica Alanya

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Objective: Palmar and axillary hyperhidrosis is caused by overstimulation of the sympathetic nervous system that control the sweat glands. This study compares the clinical consequences of uniportal and multiportal thoracic endoscopic thoracic sympathectomy (ETS), in cases of severe palmar and axillary hyperhidrosis. Methods: In this retrospective study, forty-one patients who were diagnosed as severe palmar and axillary primary hyperhidrosis were analyzed. These underwent multiportal ETS between 2015 and 2020 at our thoracic surgery clinic. They were divided into two groups, 24 as uniportal (58.5%) and 17 as multiportal (41.5%). They were compared in terms of the length of hospital stay, the initial complications and possible recurrences after three months. Descriptive statistics were used to evaluate stratified and continuous variables. Results: There was no significant difference in moderate pain between the two groups. There was a significant difference between the two groups in terms of 3 days or more hospitalization. There were no significant difference related to the rate of complications such as ptosis, Horner syndrome, increased duration of surgery and recurrence rate of hyperhidrosis 3 months after surgery. Some mild to moderate side effects disappeared spontaneously at 6-month follow-up. Conclusion: The results showed that uniportal and multiportal endoscopic thoracoscopic sympathectomy (EST) are very effective, safe and minimally invasive methods for the treatment of palmar and axillary hyperhidrosis. Compared to the multiportal approach, uniportal EST causes less postoperative pain and less surgical duration.

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Reversible anisocoria due to inadvertent ocular exposure to topical anticholinergic treatment for primary axillary hyperhidrosis

Cited by 10 publications

References 5 publications

Topical Glycopyrronium Tosylate in Primary Axillary Hyperhidrosis: A Profile of Its Use

Topical Glycopyrronium Tosylate in Primary Axillary Hyperhidrosis: A Profile of Its Use

Pharmacologic Mydriasis Secondary to Topical Glycopyrronium Tosylate Cloths: Clinical Characterization From a Multicenter Analysis

Clinical Outcomes of Uniportal Versus Multiportal Endoscopic Thoracic Sympathectomy in Patients With Severe Palmar and Axillary Hyperhidrosis

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