Epinephrine Auto-Injector

Still some doctors do not know that they can write "Epinephrine Auto-Injector" instead of EpiPen for a cheaper equally effective alternative for patients. EpiPen is still very expensive and there are cheaper alternatives.

Epinephrine 1mg/10ml (0.1mg/ml) from Lifeshield is much cheaper: this one is harder to use & you need your own 22G or 30G needle and you should only inject 1/3 of vial at a time, but it is less expensive than the alternatives. I

Stem Cell Use for Dry Eye

Today I saw another patient in her 20's who has had to quit her job because she cannot stand to look at screens. She was a computer programmer working 10hr days in front of some form of electronic screen. This is the 15th patient under the age of 30 who has quit a job because of chronic eye pain. This is unheard of in the eye surgical world. Quitting your job because of eye pain has not been published as far as a I know.

My concern is all the young children under the age of 15 with severe dry eye and meibomian gland atrophy in part due to excessive screen time. What will become of them? Why are the schools not banning screens? How can we quickly get this news spread to all schools globally?

Our Stem Cell protocol for the use to restore the meibomian glands, lacrimal gland, and mucin gland has begun thanks to a very generous donor who has contributed to our research.

We will be following patients to see if we can prove or disprove with the relatively objective test of Meibography to see if autologous stem cells work or not.




The message for everyone, is "Do not ignore your eye symptoms. Get a meibography and eyeMD check if you have any redness, tearing, burning, irritation, foreign body sensation, pain."

Risk of Vision Loss with Cymbalta and Irenka

Yes, there is a risk of bilateral acute angle closure glaucoma with Cymbalta and Irenka.
The risk is rare and usually occurs in patients who have narrow angles and are older. 
Still, be sure you do not have narrow angles (simple Pentacam can check this at your eyeMD's office), before starting Cymbalta and Irenka.
SLC

Ann Pharmacother. 2014 Jul;48(7):936-939. Epub 2014 Apr 14.

Probable Association of an Attack of Bilateral Acute Angle-Closure Glaucoma With Duloxetine.

Shifera AS1, Leoncavallo A2, Sherwood M2.

Author information

Abstract

OBJECTIVE:

To report a patient who had an attack of bilateral acute angle-closure glaucoma (ACG) probably associated with the use of duloxetine.

CASE SUMMARY:

The case reported here involves an 81-year-old Caucasian woman whose past ocular history was unremarkable except for high hyperopia and cataract. The patient developed ocular symptoms 2 days after starting duloxetine, a serotonin norepinephrine reuptake inhibitor (SNRI) and was diagnosed with acute ACG. The elevated intraocular pressure (IOP) was successfully lowered with medical treatment, and the patient was advised to discontinue duloxetine. She subsequently underwent laser iridotomy in both eyes, and her IOP remained adequately controlled. A score of 6 was obtained using the Naranjo adverse drug reaction probability scale, suggesting duloxetine as the probable cause of the attack of ACG in this patient.

DISCUSSION:

There are a few previous reports of acute ACG associated with venlafaxine, another member of the class of SNRIs. In addition, there are several reports of ACG associated with members of the related class of selective serotonin reuptake inhibitors (SSRIs)-namely, fluoxetine, paroxetine, fluvoxamine, sertraline, citalopram, and escitalopram. The mechanism responsible for the precipitation of ACG by members of these 2 classes of drugs is likely a result of mydriasis caused by their adrenergic effects, weak anticholinergic activities, or the increased levels of serotonin.

CONCLUSION:

Because the SNRIs, including duloxetine, and SSRIs are commonly used in the management of depression or chronic pain, caution is warranted with the use of these drugs in patients with risk factors for ACG.