tretinoin and Conjunctival-Diseases

Topics: Biopsy; Conjunctiva; Conjunctival Diseases; Echothiophate Iodide; Epinephrine; Humans; Idoxuridine; Immunosuppression Therapy; Pemphigoid, Benign Mucous Membrane; Pilocarpine; Quaternary Ammonium Compounds; Skin Diseases, Vesiculobullous; Timolol; Tretinoin

In a prospective, double-masked clinical study, the authors evaluated the efficacy and safety of topically applied tretinoin ophthalmic ointment (0.01%) versus placebo in the treatment of squamous metaplasia associated with various ocular surface disorders involving dry eyes. Study parameters consisted of graded symptoms and signs, and serial impression cytologies. A total of 161 patients were enrolled in the study. Of these patients, 116 who had a minimum of 4 to 8 months of follow-up qualified for final statistical analysis. These patients were classified into two major groups: (1) keratoconjunctivitis sicca (KCS) and (2) conjunctival cicatricial diseases (Stevens-Johnson syndrome, inactive pemphigoid, radiation-induced dry eye, drug-induced pseudopemphigoid, and toxic epidermal necrolysis). An analysis of adjusted mean changes for KCS patients showed no statistically significant differences between active drug and placebo. A similar analysis of patients with conjunctival cicatricial diseases indicated a statistically significant (P less than 0.05) reversal of conjunctival keratinization in the temporal bulbar site after treatment with active drug, however, clinical symptoms and signs showed no significant improvement with active drug relative to placebo. Side effects were limited to blepharoconjunctivitis and were reversible upon tapering or stopping the drug.

Topics: Administration, Topical; Adolescent; Adult; Aged; Aged, 80 and over; Conjunctiva; Conjunctival Diseases; Double-Blind Method; Epithelium; Female; Follow-Up Studies; Humans; Keratoconjunctivitis; Keratoconjunctivitis Sicca; Male; Metaplasia; Middle Aged; Multicenter Studies as Topic; Prospective Studies; Random Allocation; Tretinoin

Topics: Administration, Ophthalmic; Aged; Aged, 80 and over; Antineoplastic Agents; Conjunctival Diseases; Drug Therapy, Combination; Female; Humans; Interferon alpha-2; Male; Melanosis; Middle Aged; Ophthalmic Solutions; Retrospective Studies; Tretinoin

We report four cases of corneoconjunctival keratinization that were successfully treated with topical retinoic acid ointment. In two cases keratinization was due to squamous metaplasia and in two others it was secondary to intraepithelial corneoconjunctival neoplasia. Treatment reversed severe keratinization in a case of drug-induced pseudopemphigoid and stabilized the disease in one of the two affected eyes without additional treatment. In a case of ocular cicatricial pemphigoid, retinoic acid was useful as an adjuvant therapy to immunosuppression, by reversing keratinization of the conjunctiva. In two cases of corneoconjunctival neoplasia, lesions regressed markedly. Long-term treatment was well tolerated in three patients. Our findings suggest that retinoic acid ointment is effective in treating severe squamous metaplasia in cicatrizing diseases of the conjunctiva. Our findings indicate further that retinoic acid seems to inhibit growth of corneoconjunctival neoplasias and thus might be useful complementary therapy in this situation.

Topics: Administration, Topical; Aged; Aged, 80 and over; Conjunctiva; Conjunctival Diseases; Conjunctival Neoplasms; Conjunctivitis; Cornea; Corneal Diseases; Epithelium; Female; Humans; Keratins; Male; Metaplasia; Tretinoin

Topical all trans retinoic acid (tretinoin) 0.1 per cent has been used to treat eight patients with squamous metaplasia and keratinisation of the conjunctiva. In four patients the changes followed Stevens-Johnson syndrome, one patient had chronic atopic kerato conjunctivitis, one had persistent epithelial erosions following sarcoid related kerato conjunctivitis sicca complicated by preservative induced epithelial toxicity, one had a recurrent Bowen like epithelial dysplasia and one had an unclassifiable primary ocular surface disorder. Improvement in symptoms and signs were noted in all patients but local irritation developed in some and the optimum dosage remains to be determined. Problems of formulation and stability of the preparation need to be solved before topical retinoid therapy can be more widely used.

Topics: Administration, Topical; Adolescent; Adult; Aged; Antineoplastic Agents; Conjunctiva; Conjunctival Diseases; Female; Humans; Keratoconjunctivitis; Male; Metaplasia; Middle Aged; Tretinoin