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Russell S. Gonnering, MD
Milwaukee

Arch Ophthalmol. 1989;107(2):169.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

In Reply.

—While I thank Dr Haddad for pointing out the possible use of guanethidine monosulfate in the treatment of lid retraction, I believe certain aspects of its use need review.

In 1964, Dorian and Schirmer¹ reported that topically applied guanethidine monosulfate produced a sympatholytic Horner's syndrome. In 1966, Gay and Wolkstein,² and Sneddon and Turner,³ recommended the instillation of a 10% solution of guanethidine monosulfate for the treatment of lid retraction in thyroid-associated orbitopathy. Crombie and Lawson⁴ reported a reduction of palpebral fissure height by over 20% in nine of 20 patients treated for a mean duration of 16 weeks. However, they noticed a disturbing side effect of punctate epithelial keratopathy in 50% of patients and recommended reducing the concentration to 5%.

Topical guanethidine, particularly when combined with epinephrine, has also been noted to be a potentially useful agent in the treatment of glaucoma. Hoyng . . . [Full Text PDF of this Article]

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