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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. 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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  1. Ditropan-associated Esotropia Dr. Elaine Wong Dr. Lionel Kowal Ocular motility clinic, RVEEH CERA, Uni Melb, RVEEH

  2. 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

  3. Examination @ presentation • VAR 6/8 VAL 6/8 • Near VAR 6/9 VAL 6/8 • Stereopsis: Titmus fly 100” • CT: D) RET 15Δ N) RET’ 35Δ • OM: normal • Polarised 4 dot test: R suppression • Cycloplegic refraction: • R: +3.25; L + 2.75

  4. Ditropan-associated ET • After cessation of Oxybutynin • VAR 6/8 VAL 6/8 • Near VAR 6/6 VAL6/8 • CT: D) orthophoria • N) orthophoria • ELAINE : CHECK THE DATA ON THIS SLIDE PLS • Polarised 4 dot test: Fusion • Stereopsis: Titmus fly 100”

  5. Discussion - Oxybutynin • Muscarinic receptor antagonist often used for overactive bladder • COMMONLY PRESCRIBED • Anticholinergic systemic SE • Ocular effects • Ciliary ganglion – accomodation • Pterygopalatine ganglion – lacrimation

  6. 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

  7. Discussion Tolterodine Oxybutynin Accom amp (DS) 2.06 to 1.65 2.18 to 1.80 (p = 0.07) (p = 0.003) Schirmer’s (mm) 12.82 to 12.32 12.21 to 14.83 (p = 0.698) (p = 0.342) PD bright (mm) 1.94 to 2.02 2.07 to 2.08 (p = 0.174) ( p = 0.953)

  8. 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

  9. 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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