Unwanted pharmacological effects of local guanethidine in the treatment of dysthyroid upper lid retraction.

Adrenergic blocking agents have had an occasional and limited use in ophthalmology for several years but are now being used with increasing frequency in the treatment of glaucoma and of the eye signs of accompanying thyroid dysfunction. Several trials of the therapeutic uses of local adrenergic blocking agents have been made and these indicate that, of the agents tested (including Bethanidine, Guanethidine, Phentolamine, and Propanolol), Guanethidine is the most effective (Lee, Morimoto, Bronsky, and Waldstein, I 96 I; Gay and Wolkstein, I 966; Sneddon and Turner, I 966; Gay, Salmon, and Wolkstein, 1967). Accordingly, with increasing interest in dysthyroid ophthalmopathy, trials have recently been made of the use of Guanethidine in treating upper lid retraction and exophthalmos and, as local toxic effects have been met in some of these trials, including a short-term trial with fourteen patients (Sneddon and Turner, I966) and a long-term trial with twenty patients and an average duration of i6 weeks (Crombie and Lawson, I967), 81 patients in a recent extended trial have been examined in detail to determine if local Guanethidine has any serious side-effects.