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Use of Privine-Antistine Drops in Ophthalmology*
NOTES, CASES, INSTRUMENTS in a total tarsorrhaphy, although strange, is not unpleasant as with the more usual procedures. For the same reason the cosmetic effect is definitely superior in partial tarsorrhaphies, the eye acquiring a "dreamy" look, rather than the "tampered with" appearance of the usual procedures. The presence of the lashes hides the scar of union, too. The greatest advantage, however, is the permanence of the procedure. It is permanent because the union is a fibrous one between the orbicularis muscle fibers, and there is no tension on the skin. In cases of muroparalytic keratitis, the lid sutures should not be tied too tightly, or else the already atrophie skin might die and slough away, causing a scar. I wish to record my thanks to Mr. J. P. F. Lloyd, the senior surgeon, for his constant encouragement in this and other work. USE O F P R I V I N E - A N T I S T I N E DROPS IN OPHTHALMOLOGY* RAY K.
DAILY,
M.D.,
AND
Louis DAILY, JR., M.D. Houston, Texas This is a combination of two drugs,+ Privine and Antistine. Privine is chemically a naphthyl-methylimidazoline hydrochloride. It is a crystalline colorless substance soluble in water and in saline solution. The solution is stable and is not decomposed by exposure to light or air. Its pharmacologie properties were described in 1941 by Meier and Müller. Instilled into the conjunctival sac it produces a vasoconstriction similar to that of adrenalin; it lasts longer and there is no secondary vasodilatation. The blanching of the conjunctiva sets in rapidly, lasts about 2 to 3 hours, and then slowly recedes ; it acts * From the Department of Ophthalmology, Baylor University College of Medicine. t Manufactured by the Ciba Pharmaceutical Products, Inc.
441
principally on the small conjunctival vessels. The effect on the larger vessels and on the ciliary and episcleral vessels is less pronounced. It is a sympathetic stimulant and produces a slight widening of the palpebral fissures through contraction of the musculus tarsalis superior. It also produces a perceptible pupillary dilatation by its effect on the dilator pupillae. The mydriasis is noticeable only in dim light and in eyes with blue irises. In daylight and in brown eyes the mydriasis is uncertain. It disappears in several hours and does not cause dazzling. The pupillary reactions, accommodation, and corneal sensitivity remain normal. The effect on the intraocular pressure is insignificant. Bürki 2 in the report of his clinical investigations states that he did not see a single case of a rise in intraocular pressure. Fanta 3 of the Lindner Clinic found a few cases in which the instillation was followed by a brief and insignificant increase in tension. Antistine, a synthetic antihistaminic drug, is a crystalline, white odorless powder, the chemical formula of which is phenyl-benzylaminomethylimidazoline. Its sulphate, used for the ophthalmic solution has a pH of 6.9. It is prepared in an isotonic buffered solution with the following formula— antistine sulphate, 18.75 gm. ; sodium carbonate anhydrous, 2.66 gm. ; potassium chloride, 27.75 gm. ; boric acid, 46.50 gm. ; distilled water, 3,750 cc. Bourquin 1 reported on the use of this solution in 37 cases of various types of conjunctivitis and scleritis. He found that its instillation relieved photophobia, itching, and lacrimation, and was of value in giving symptomatic relief, although it had no permanent effect on allergic conditions. A combination* of 0.5-percent Antistine with 0.025-percent Privine has been used by us in about 100 cases of various types of conjunctivitis. * Supplied for experimental purposes by the Ciba Pharmaceutical Products, Inc.
442
NOTES, CASES, INSTRUMENTS
Its vasoconstricting effect and its calming action, on blepharospasm make it useful in a number of conjunctival and corneal diseases. The effect varies in different patients, both as to intensity and duration. Its instillation produces a short transitory smarting sensation. One patient with keratoconjunctivitis sicca, on whom it was tried, complained that after the instillation of the solution the eyes burned for a considerable period of time, but that the eyes were very comfortable for some time afterward. The solution is particularly suitable for cases characterized by conjunctival congestion. It is used gratefully by patients who complain of burning, itching, photophobia, lacrimation, or dryness, a sensation of sand in the eyes, fatigue and blurring of vision, particularly in the evening. In most of these patients the objective data are not commensurate with their subjective symptoms. In many cases there is no objective pathologic condition; the conjunctival scrapings are negative for microorganisms ; the lacrimal passages are normal ; the refractive error is corrected. In some cases there is a mild subacute or chronic conjunctivitis with moderate redness and swelling of the palpebral and fornix conjunctiva. Occasionally, there is more pronounced conjunctival hyperemia and infiltration with a few follicles. In such cases instillation of Antistine-Privine drops every four hours brings prompt subjective amelioration. The alleviation of subjective complaints is superior to that obtained from the instillation of weak zinc sulphate, resorcin, or mercury oxycyanide, the medicaments which usually give transitory relief to such patients. Since Antistine-Privine solution may be
used indefinitely, it is a useful addition to our list of medicaments for chronic conjunctivitis. It is appreciated by patients with allergic conjunctivitis, who complain of photophobia and lacrimation. In eczematous keratitis, it is said to reduce the inflammatory symptoms by decongestion of the conjunctiva, and to diminish the corneal vascularization with a salutory effect on the visual outcome. The solution may be combined with astringents in chronic conjunctivitis, or with silver preparations in acute conjunctivitis. In scleritis and episcleritis the bulbar congestion is reduced, and the patient gets a sense of subjective improvement, but the effect is not as pronounced as it is in conjunctivitis. It is also useful for the relief of postoperative discomfort due to persistent conjunctival hyperemia. In persistent conjunctival irritation following trauma, burns, and chemical injuries, the instillation of the drops causes a blanching of the conjunctiva, and gives the patient a sensation of relief. In combination with local anesthetics, such as pontocaine or holocaine, it reduces the conjunctival irritation frequently produced by these anesthetics. This is an advantage when repeated applications are necessary, as in taking tension curves. It can also be used in place of adrenalin instillations in surgical procedures. SUMMARY
The combination of Antistine-Privine drops is a valuable addition to our therapeutic armamentarium. Instilled into the conjunctival sac it produces a rapid decongestion of the conjunctiva, which is agreeable in a number of conjunctival conditions. Medical Arts Building (2).
REFERENCES
1. Bourquin, J. B. : A new synthetic antihistaminic substance (Antistine) and its use in ophthalmology. Schweiz, med. Wchnschr., 76:296-300 (April) 1946. 2. Bürki, E. : Die therapeutische Verwendung des Privin (Ciba) in der Ophthalmologie. Ophthalraologica, 104:254-263 (Nov.) 1942. 3. Fanta, H. : Die Wirking des Privin auf das normale und kranke Auge. Klin. Med., 2:68-73, 1946.
DAILY,
M.D.,
AND
Louis DAILY, JR., M.D. Houston, Texas This is a combination of two drugs,+ Privine and Antistine. Privine is chemically a naphthyl-methylimidazoline hydrochloride. It is a crystalline colorless substance soluble in water and in saline solution. The solution is stable and is not decomposed by exposure to light or air. Its pharmacologie properties were described in 1941 by Meier and Müller. Instilled into the conjunctival sac it produces a vasoconstriction similar to that of adrenalin; it lasts longer and there is no secondary vasodilatation. The blanching of the conjunctiva sets in rapidly, lasts about 2 to 3 hours, and then slowly recedes ; it acts * From the Department of Ophthalmology, Baylor University College of Medicine. t Manufactured by the Ciba Pharmaceutical Products, Inc.
441
principally on the small conjunctival vessels. The effect on the larger vessels and on the ciliary and episcleral vessels is less pronounced. It is a sympathetic stimulant and produces a slight widening of the palpebral fissures through contraction of the musculus tarsalis superior. It also produces a perceptible pupillary dilatation by its effect on the dilator pupillae. The mydriasis is noticeable only in dim light and in eyes with blue irises. In daylight and in brown eyes the mydriasis is uncertain. It disappears in several hours and does not cause dazzling. The pupillary reactions, accommodation, and corneal sensitivity remain normal. The effect on the intraocular pressure is insignificant. Bürki 2 in the report of his clinical investigations states that he did not see a single case of a rise in intraocular pressure. Fanta 3 of the Lindner Clinic found a few cases in which the instillation was followed by a brief and insignificant increase in tension. Antistine, a synthetic antihistaminic drug, is a crystalline, white odorless powder, the chemical formula of which is phenyl-benzylaminomethylimidazoline. Its sulphate, used for the ophthalmic solution has a pH of 6.9. It is prepared in an isotonic buffered solution with the following formula— antistine sulphate, 18.75 gm. ; sodium carbonate anhydrous, 2.66 gm. ; potassium chloride, 27.75 gm. ; boric acid, 46.50 gm. ; distilled water, 3,750 cc. Bourquin 1 reported on the use of this solution in 37 cases of various types of conjunctivitis and scleritis. He found that its instillation relieved photophobia, itching, and lacrimation, and was of value in giving symptomatic relief, although it had no permanent effect on allergic conditions. A combination* of 0.5-percent Antistine with 0.025-percent Privine has been used by us in about 100 cases of various types of conjunctivitis. * Supplied for experimental purposes by the Ciba Pharmaceutical Products, Inc.
442
NOTES, CASES, INSTRUMENTS
Its vasoconstricting effect and its calming action, on blepharospasm make it useful in a number of conjunctival and corneal diseases. The effect varies in different patients, both as to intensity and duration. Its instillation produces a short transitory smarting sensation. One patient with keratoconjunctivitis sicca, on whom it was tried, complained that after the instillation of the solution the eyes burned for a considerable period of time, but that the eyes were very comfortable for some time afterward. The solution is particularly suitable for cases characterized by conjunctival congestion. It is used gratefully by patients who complain of burning, itching, photophobia, lacrimation, or dryness, a sensation of sand in the eyes, fatigue and blurring of vision, particularly in the evening. In most of these patients the objective data are not commensurate with their subjective symptoms. In many cases there is no objective pathologic condition; the conjunctival scrapings are negative for microorganisms ; the lacrimal passages are normal ; the refractive error is corrected. In some cases there is a mild subacute or chronic conjunctivitis with moderate redness and swelling of the palpebral and fornix conjunctiva. Occasionally, there is more pronounced conjunctival hyperemia and infiltration with a few follicles. In such cases instillation of Antistine-Privine drops every four hours brings prompt subjective amelioration. The alleviation of subjective complaints is superior to that obtained from the instillation of weak zinc sulphate, resorcin, or mercury oxycyanide, the medicaments which usually give transitory relief to such patients. Since Antistine-Privine solution may be
used indefinitely, it is a useful addition to our list of medicaments for chronic conjunctivitis. It is appreciated by patients with allergic conjunctivitis, who complain of photophobia and lacrimation. In eczematous keratitis, it is said to reduce the inflammatory symptoms by decongestion of the conjunctiva, and to diminish the corneal vascularization with a salutory effect on the visual outcome. The solution may be combined with astringents in chronic conjunctivitis, or with silver preparations in acute conjunctivitis. In scleritis and episcleritis the bulbar congestion is reduced, and the patient gets a sense of subjective improvement, but the effect is not as pronounced as it is in conjunctivitis. It is also useful for the relief of postoperative discomfort due to persistent conjunctival hyperemia. In persistent conjunctival irritation following trauma, burns, and chemical injuries, the instillation of the drops causes a blanching of the conjunctiva, and gives the patient a sensation of relief. In combination with local anesthetics, such as pontocaine or holocaine, it reduces the conjunctival irritation frequently produced by these anesthetics. This is an advantage when repeated applications are necessary, as in taking tension curves. It can also be used in place of adrenalin instillations in surgical procedures. SUMMARY
The combination of Antistine-Privine drops is a valuable addition to our therapeutic armamentarium. Instilled into the conjunctival sac it produces a rapid decongestion of the conjunctiva, which is agreeable in a number of conjunctival conditions. Medical Arts Building (2).
REFERENCES
1. Bourquin, J. B. : A new synthetic antihistaminic substance (Antistine) and its use in ophthalmology. Schweiz, med. Wchnschr., 76:296-300 (April) 1946. 2. Bürki, E. : Die therapeutische Verwendung des Privin (Ciba) in der Ophthalmologie. Ophthalraologica, 104:254-263 (Nov.) 1942. 3. Fanta, H. : Die Wirking des Privin auf das normale und kranke Auge. Klin. Med., 2:68-73, 1946.