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Ophthalmic Ointments: Editor
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AMERICAN JOURNAL OF OPHTHALMOLOGY
healing. I believe that wound healing of the cornea is such an important topic that all of the various factors involved must be con sidered and that one is not justified in ex trapolating effects on one system to the entire mechanism of the wound healing. Frank W. Newell, M.D. Editor, American Journal of Ophthalmology: I was pleased to learn that ophthalmic ointments do not interfere with healing of corneal wounds (Am. J. Ophthalmol. 76: 193, 1973). Occasionally, however, untoward consequences have followed their use. The late Derrick Vail noted in his travels a case in which some of the ointment seeped into the anterior chamber causing a globule of oil to appear therein. According to my observations, atropine sensitivity is likely to occur more often and much sooner with the use of ointments than with eyedrops, and when it does occur the atropine sensitivity may include the ointment base also. Inci dentally, the instillation of any ointment in a patient's only seeing eye is psychologically distressing because of the transient visual blur that follows. James E. Lebensohn, M.D. Chicago, Illinois REPLY
Editor, American Journal of Ophthalmology: Dr. Lebensohn points out the complication of anterior chamber ointment entrapment especially postoperatively as outlined by Scheie, Rubenstein, and Katowitz,1 and Sugar and Airala.2 Further data on this and indications and contraindications for oint ment use are given in other articles.3'4 As pointed out by Ellis and Smith,5 some possi ble disadvantages of ointment usage include increase in contact dermatitis and blurring of vision. It is not possible to trap ointments in the corneas of experimental animals un less the ointment is totally surrounded by
DECEMBER, 1973
stroma.4 Pseudocorneal ointment entrapment has been occasionally observed when oint ments are used with a firm pressure bandage. This entity will be described in a future report.6 In our paper, we wrote "Most experi mental investigations of the effects of oint ment on corneal re-epithelization and stromal wound healing were carried out two or three decades ago." Current textbooks on oph thalmology based on these earlier reports state that ophthalmic ointments retard cor neal wound healing. However, even these original experiments were at variance as to the nonemulsive type of ointment in alter ing corneal healing. We must apologize to Dr. Newell for making an assumption that the work cited in his excellent textbook was the study of Dr. Smelser.7 Dr. Smelser burned rat corneas and noted the rate of re-epithelization. The hourly application of many substances included lanolin alone which only slightly decreased the number of mitoses. In fact, the difference from the controls were "on the borderline of statisti cal significance."7 The petrolatum and lanolin available in 1945 were impure compared to modern ophthalmic ointments. Further, mod ern ointments employ a much less viscous petrolatum or a mixture of petrolatum and liquid mineral oil to which only a few per cent of purified lanolin is sometimes added. Dr. Newell is correct in saying that we did not study all factors in healing such as mitosis. However, we did study the effects of modern ointments on overall wound heal ing and could detect no slowing of the heal ing process. Calvin Hanna, Ph.D. F. T. Fraunfelder, M.D. M. Cable, B.S. R. E. Hardberger, M.D. Little Rock, Arkansas REFERENCES
1. Scheie, H. G., Rubenstein, R. A., and Kato witz, J. A.: Ophthalmic ointment bases in the an terior chamber. Arch. Ophthalmol. 73:36, 1965. 2. Sugar, H. S. and Airala, M. A. : Introduction
AMERICAN JOURNAL OF OPHTHALMOLOGY
healing. I believe that wound healing of the cornea is such an important topic that all of the various factors involved must be con sidered and that one is not justified in ex trapolating effects on one system to the entire mechanism of the wound healing. Frank W. Newell, M.D. Editor, American Journal of Ophthalmology: I was pleased to learn that ophthalmic ointments do not interfere with healing of corneal wounds (Am. J. Ophthalmol. 76: 193, 1973). Occasionally, however, untoward consequences have followed their use. The late Derrick Vail noted in his travels a case in which some of the ointment seeped into the anterior chamber causing a globule of oil to appear therein. According to my observations, atropine sensitivity is likely to occur more often and much sooner with the use of ointments than with eyedrops, and when it does occur the atropine sensitivity may include the ointment base also. Inci dentally, the instillation of any ointment in a patient's only seeing eye is psychologically distressing because of the transient visual blur that follows. James E. Lebensohn, M.D. Chicago, Illinois REPLY
Editor, American Journal of Ophthalmology: Dr. Lebensohn points out the complication of anterior chamber ointment entrapment especially postoperatively as outlined by Scheie, Rubenstein, and Katowitz,1 and Sugar and Airala.2 Further data on this and indications and contraindications for oint ment use are given in other articles.3'4 As pointed out by Ellis and Smith,5 some possi ble disadvantages of ointment usage include increase in contact dermatitis and blurring of vision. It is not possible to trap ointments in the corneas of experimental animals un less the ointment is totally surrounded by
DECEMBER, 1973
stroma.4 Pseudocorneal ointment entrapment has been occasionally observed when oint ments are used with a firm pressure bandage. This entity will be described in a future report.6 In our paper, we wrote "Most experi mental investigations of the effects of oint ment on corneal re-epithelization and stromal wound healing were carried out two or three decades ago." Current textbooks on oph thalmology based on these earlier reports state that ophthalmic ointments retard cor neal wound healing. However, even these original experiments were at variance as to the nonemulsive type of ointment in alter ing corneal healing. We must apologize to Dr. Newell for making an assumption that the work cited in his excellent textbook was the study of Dr. Smelser.7 Dr. Smelser burned rat corneas and noted the rate of re-epithelization. The hourly application of many substances included lanolin alone which only slightly decreased the number of mitoses. In fact, the difference from the controls were "on the borderline of statisti cal significance."7 The petrolatum and lanolin available in 1945 were impure compared to modern ophthalmic ointments. Further, mod ern ointments employ a much less viscous petrolatum or a mixture of petrolatum and liquid mineral oil to which only a few per cent of purified lanolin is sometimes added. Dr. Newell is correct in saying that we did not study all factors in healing such as mitosis. However, we did study the effects of modern ointments on overall wound heal ing and could detect no slowing of the heal ing process. Calvin Hanna, Ph.D. F. T. Fraunfelder, M.D. M. Cable, B.S. R. E. Hardberger, M.D. Little Rock, Arkansas REFERENCES
1. Scheie, H. G., Rubenstein, R. A., and Kato witz, J. A.: Ophthalmic ointment bases in the an terior chamber. Arch. Ophthalmol. 73:36, 1965. 2. Sugar, H. S. and Airala, M. A. : Introduction