Lid Retraction Therapy With a Guanethidine Solution-Reply

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