Ditropan associated esotropia
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Ditropan-associated Esotropia. Dr. Elaine Wong Dr. Lionel Kowal Ocular motility clinic, RVEEH CERA, Uni Melb, RVEEH. Ditropan-associated ET. 5 yo girl PMHx Hypothyroidism – on oroxine Enuresis HOPC Recent onset intermittent ET Closing L eye when drawing or reading

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Ditropan-associated Esotropia

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Ditropan associated esotropia

Ditropan-associated Esotropia

Dr. Elaine Wong

Dr. Lionel Kowal

Ocular motility clinic, RVEEH

CERA, Uni Melb, RVEEH


Ditropan associated et

Ditropan-associated ET

  • 5 yo girl

    PMHx

  • Hypothyroidism – on oroxine

  • Enuresis

    HOPC

  • Recent onset intermittent ET

  • Closing L eye when drawing or reading

  • Recently started on Ditropan (Oxybutynin) for enuresis


Examination @ presentation

Examination @ presentation

  • VAR 6/8VAL 6/8

  • Near VAR 6/9 VAL 6/8

  • Stereopsis: Titmus fly 100”

  • CT: D) RET 15ΔN) RET’ 35Δ

  • OM: normal

  • Polarised 4 dot test: R suppression

  • Cycloplegic refraction:

  • R: +3.25; L + 2.75


Ditropan associated et1

Ditropan-associated ET

  • After cessation of Oxybutynin

  • VAR 6/8VAL 6/8

  • Near VAR 6/6VAL6/8

  • CT: D) orthophoria

  • N) orthophoria

  • ELAINE : CHECK THE DATA ON THIS SLIDE PLS

  • Polarised 4 dot test: Fusion

  • Stereopsis: Titmus fly 100”


Discussion oxybutynin

Discussion - Oxybutynin

  • Muscarinic receptor antagonist often used for overactive bladder

  • COMMONLY PRESCRIBED

  • Anticholinergic systemic SE

  • Ocular effects

    • Ciliary ganglion – accomodation

    • Pterygopalatine ganglion – lacrimation


Ocular side effects of tolterodine and oxybutynin a single blind prospective randomized trial

Ocular side-effects of tolterodine and oxybutynin, a single-blind prospective randomized trial

Altan-Yaycioglu et al. Br J Clin Pharmacol 95:5, 588-592

  • 52 patients, 104 eyes

  • Randomised into

    • Tolterodine 2mg bd – 28 pts

    • Oxybutynin 5 mg tds – 24 pts

  • All examined by ophthalmologists

    • Schirmer’s

    • Accomodative amplitude

    • Pupillary diameter PD


Discussion

Discussion

TolterodineOxybutynin

Accom amp (DS)2.06 to 1.652.18 to 1.80

(p = 0.07)(p = 0.003)

Schirmer’s (mm)12.82 to 12.3212.21 to 14.83

(p = 0.698)(p = 0.342)

PD bright (mm)1.94 to 2.022.07 to 2.08

(p = 0.174)( p = 0.953)


Discussion1

Discussion

  • In this case Oxybutynin

    • Impairs accommodation

    • Pre-existing moderate uncorrected +

    • To accommodate sufficiently to see, the pt converges, and the CA/C ratio then generates accommodation

    • hence ESOTROPIA!!!

    • ? Is Tolterodine (Detrusitol) safer


Ditropan

Ditropan

  • Frequently prescribed

  • Has never been described as cause of ET!

  • Likely to cause accommodation and  convergence

  • Dit + hyperopia likely to cause ET

  • Almost certainly underrecognised


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