Naphazoline 0.012% eye drops

Conjunctival hyperemia is one of the most frequent ophthalmologic presentations and may adversely affect quality of life due to associated discomfort and aesthetic concerns. In many countries, the prevalence of noninfectious conjunctival hyperemia is increasing due to lifestyle factors and the shift to technology-based employment. Management of noninfectious conjunctival hyperemia is typically aimed at addressing the underlying cause while alleviating signs and symptoms. However, an underlying cause might not be identified, treatment may not immediately reduce redness, or residual redness might persist. Topical treatment options include lubricants, decongestants, antihistamines/mast cell stabilizers, and anti-inflammatory drugs. Among these, ocular decongestants provide effective short-term relief, but the use of α1- (phenylephrine, tetrahydrozoline) or mixed α1/α2- (naphazoline, oxymetazoline) adrenergic receptor agonists is associated with tachyphylaxis and rebound redness. A highly selective α2- adrenergic receptor agonist (brimonidine 0.025%) reduces ocular redness without evidence of tachyphylaxis over 29 days and with minimal rebound redness upon discontinuation; however, longer-term effectiveness has not been evaluated. Other unmet needs pertain to the management of noninfectious conjunctival hyperemia as an aesthetic issue and the need to educate patients about the risks of surgical eye-whitening procedures and national recalls. Region- or country-specific unmet needs include a lack of awareness of the need for clinical assessment and appropriate treatment of ocular redness. While many cases of noninfectious conjunctival hyperemia can be self-treated, unmet needs remain with respect to access to care and patient awareness/knowledge of safe and appropriate treatment options and the importance of clinical consultation. The development of management guidelines specific to noninfectious conjunctival hyperemia is warranted to address patients' clinical and aesthetic concerns.

Abstract licence: CC BY-NC

Sir, Idiopathic fetal ductal constriction is a reversible cause of hydrops. Timely detection and prompt induction of preterm delivery are essential for improving fetal outcomes. We hereby report an uncomplicated survival of a preterm fetus despite ductal constriction with right ventricular dysfunction and hydrops. A 30-year-old multigravida was referred at 33 weeks of gestation for fetal pericardial effusion. The previous two pregnancies had resulted in early neonatal death at 3 h and 3 days, respectively. Detailed records related to the events were not available. Hence, the exact reason for recurrent neonatal deaths was not known. Fetal echocardiography revealed a structurally normal heart. The ductus arteriosus (DA), however, had continuous flow with peak gradients >2 m/s throughout the cardiac cycle, thus indicating severe constriction [Figure 1]. The right ventricle (RV) was hypertrophied, dilated, and dysfunctional [Figure 2a]. The fetus also had severe tricuspid regurgitation (TR) and mild pericardial effusion [Figure 2b]. The diastolic flow in the ductus venosus was also absent. There was no history of intake of non-steroidal anti-inflammatory drugs (NSAIDS), selective serotonin reuptake inhibitors (fluoxetine), adrenergic alpha agonist (oxymetazoline, naphazoline), polyphenol-rich substances (herbal tea, caffeine) or exposure to chemical solvents. Considering the comprised hemodynamics of the fetus, preterm delivery was contemplated, and antenatal corticosteroids were administered. Strict and intensive fetal surveillance was carried out by biophysical profile. She underwent a cesarean section at 34 weeks 2 days and delivered a male baby weighing 2750 g with an Apgar score of 9 at one and 10 minutes. The perinatal transition was uneventful. Echocardiography on day 3 showed mild RV dysfunction (tricuspid annular plane systolic excursion-24 mm [normal -33mm]) and bidirectional shunt across the patent foramen ovale. In the absence of tricuspid and pulmonary regurgitation, estimation of pulmonary artery pressure could not be done; however, no features suggestive of pulmonary hypertension were present. There was no evidence of a patent ductus arteriosus. There was no arterial desaturation.Figure 1: Pulse wave Doppler across the ductus arteriosus showing continuous gradient with systolic velocity of 2.5 m/s and diastolic velocity of 1.9 m/sFigure 2: (a) Axial four chamber view showing the dilated right ventricle (RV) and right atrium (RA). (b) Color doppler across the atrioventricular valve showing severe tricuspid regurgitation. RA: right atrium, RV: Right ventricle; LV: Left ventricleIntrauterine constriction of DA, defined by continuous flow with a peak velocity of more than 1.49 m/s, is a serious condition with most fetuses developing RV dysfunction. Although commonly related to maternal exposure to drugs or chemicals, in one-sixth of fetuses, constriction of DA is idiopathic.[1] A relatively late median fetal age of 34 weeks at diagnosis makes preterm delivery of the fetus an easy and effective treatment strategy. Although 18% of neonates have persistent pulmonary hypertension, the majority have good clinical outcomes. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Abstract licence: CC BY-NC-SA