—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
Gonnering RS. Lid Retraction Therapy With a Guanethidine Solution-Reply. Arch Ophthalmol. 1989;107(2):169. doi:10.1001/archopht.1989.01070010175012
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