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Broad spectrum treatment for ocular Insult induced by organophosphate chemical warfare agents.
Toxicol Sci. 2020 Jun 24 [Online ahead of print]TS

Abstract

Warfare organophosphates (OP) nerve agents constitute one of the prime threats to mankind on the battlefield and in the scenario of civilian terror. Exposure to OP nerve agents dose-dependently result in incapacitation. They affect multiple organs, but the eye is one of the first and most frequently affected. Ocular OP insult may result in long-term miosis, impaired visual function and ocular pain thus inducing functional incapacitation. The currently recommended military medical doctrine of using 1% atropine eye drops is far from being the optimal treatment. Although effective in reducing ocular pain and the miotic response, this treatment induces long-term mydriasis and cycloplegia promoting photophobia and restricted accommodation, which may result in further impairment in visual function. An optimal treatment must ameliorate the long-term ocular insult enabling rapid return of normal visual function, while avoiding the induction of mydriasis and cycloplegia side effects, which could possibly worsen the visual performance. Optimal treatment should also keep effects of misuse to a minimum. Work done in recent years examined treatments with various anti-cholinergic drugs alone or used in combination with oxime treatments and may offer improved efficacy in ameliorating the ocular insult. This review is a summary of the applied research in animals and will discuss clinical implications and possible alterations in treatment protocols following OP exposure. Taken together the data points towards the use of topical low concentrations of potent anticholinergic ophthalmic drops such as atropine or homatropine, which rapidly ameliorate the long term OP induced ocular insult.

Authors+Show Affiliations

Department of Pharmacology, Israel Institute for Biological Research P.O. BOX 19 Ness-Ziona, Israel.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32579218

Citation

Gore, Ariel. "Broad Spectrum Treatment for Ocular Insult Induced By Organophosphate Chemical Warfare Agents." Toxicological Sciences : an Official Journal of the Society of Toxicology, 2020.
Gore A. Broad spectrum treatment for ocular Insult induced by organophosphate chemical warfare agents. Toxicol Sci. 2020.
Gore, A. (2020). Broad spectrum treatment for ocular Insult induced by organophosphate chemical warfare agents. Toxicological Sciences : an Official Journal of the Society of Toxicology. https://doi.org/10.1093/toxsci/kfaa095
Gore A. Broad Spectrum Treatment for Ocular Insult Induced By Organophosphate Chemical Warfare Agents. Toxicol Sci. 2020 Jun 24; PubMed PMID: 32579218.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Broad spectrum treatment for ocular Insult induced by organophosphate chemical warfare agents. A1 - Gore,Ariel, Y1 - 2020/06/24/ PY - 2020/03/26/received PY - 2020/05/24/revised PY - 2020/06/12/accepted PY - 2020/6/25/entrez KW - Anticholinergic treatments KW - Atropine KW - Homatropine KW - VX KW - mydriasis KW - organophosphates KW - oxime KW - sarin JF - Toxicological sciences : an official journal of the Society of Toxicology JO - Toxicol. Sci. N2 - Warfare organophosphates (OP) nerve agents constitute one of the prime threats to mankind on the battlefield and in the scenario of civilian terror. Exposure to OP nerve agents dose-dependently result in incapacitation. They affect multiple organs, but the eye is one of the first and most frequently affected. Ocular OP insult may result in long-term miosis, impaired visual function and ocular pain thus inducing functional incapacitation. The currently recommended military medical doctrine of using 1% atropine eye drops is far from being the optimal treatment. Although effective in reducing ocular pain and the miotic response, this treatment induces long-term mydriasis and cycloplegia promoting photophobia and restricted accommodation, which may result in further impairment in visual function. An optimal treatment must ameliorate the long-term ocular insult enabling rapid return of normal visual function, while avoiding the induction of mydriasis and cycloplegia side effects, which could possibly worsen the visual performance. Optimal treatment should also keep effects of misuse to a minimum. Work done in recent years examined treatments with various anti-cholinergic drugs alone or used in combination with oxime treatments and may offer improved efficacy in ameliorating the ocular insult. This review is a summary of the applied research in animals and will discuss clinical implications and possible alterations in treatment protocols following OP exposure. Taken together the data points towards the use of topical low concentrations of potent anticholinergic ophthalmic drops such as atropine or homatropine, which rapidly ameliorate the long term OP induced ocular insult. SN - 1096-0929 UR - https://www.unboundmedicine.com/medline/citation/32579218/Broad_spectrum_treatment_for_ocular_Insult_induced_by_organophosphate_chemical_warfare_agents L2 - https://academic.oup.com/toxsci/article-lookup/doi/10.1093/toxsci/kfaa095 DB - PRIME DP - Unbound Medicine ER -
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