Phospholine Iodide*

Accommodative esotropia may prevent
a child from developing the skills necessary
for competitive sports. Lack of binocular
single vision may affect school work as well
as play.. .and negative cosmetic effects
may alter peer relationships.
Phospholine Iodide
(echothiophate iodide) may be
able to change the lineup.
Diagnosis...To help determine if there
is an accommodative basis for the esotropia,
onedrop of PHOSPHOLINE IODIDE
0.125% may be instilled daily in each eye,
prior to retiring, for two or three weeks..
Treatment... If there is a significant
accommodative factor present, the continued
use of PHOSPHOLINE IODIDE
alone is often sufficient for treatment, as
long as the drug is well tolerated.
PHOSPHOLINE IODIDE acts by altering
the accommodative convergence/accommodation
relationship in a favorable way,
so that near vision is obtained with less
accommodative effort, and fusion can be
maintained.
If surgery is necessary, postoperative use
of PHOSPHOLINE IODIDE may help
correct a residual deviation.
Phospholine
Iodide*
[ECHOTHIOPHATE
IODIDE FOR OPHTHALMIC
SOLUTION]
in the diagnosis and
treatment of accommodative
esotropia
BRIEF SUMMARY
(For full prescribing information, see package circular.)
PHOSPHOLINE IODIDE®
(ECHOTHIOPHATE IODIDE FOR OPHTHALMIC SOLUTION)
PHOSPHOLINE IODIDE is a long-acting cholinesterase inhibitor for
topical use.
Indications: Glaucoma—Chronic open-angle glaucoma. Subacute
or chronic angle-closure glaucoma after iridectomy or where surgery
is refused or contraindicated. Certain non-uveitic secondary types of
glaucoma, especially glaucoma following cataract surgery.
Accommodative esotropia—Concomitant esotropias with a significant
accommodative component.
Contraindications: 1. Active uveal inflammation.
2. Most cases of angle-closure glaucoma, due to the possibility of
increasing angle block.
3. Hypersensitivity to the active or inactive ingredients.
Warnings: 1. Use in Pregnancy: Safe use of anticholinesterase medications
during pregnancy has not been established, nor has the absence
of adverse effects on the fetus or on the respiration of the neonate.
2. Succinylcholine should be administered only with great caution, if
at all, prior to or during general anesthesia to patients receiving anticholinesterase
medication because of possible respiratory or cardiovascular
collapse.
3. Caution should be observed in treating glaucoma with
PHOSPHOLINE IODIDE in patients who are at the same time undergoing
treatment with systemic anticholinesterase medications for
myasthenia gravis, because of possible adverse additive effects.
Precautions: 1. Gqnioscopy is recommended prior to initiation of therapy.
2. Where there is a quiescent uveitis or a history of this condition,
anticholinesterase therapy should be avoided or used cautiously because
of the intense and persistent miosis and ciliary muscle contraction
that may occur.
3. While systemic effects are infrequent, proper use of the drug requires
digital compression of the nasolacrimal ducts for a minute or two
following instillation to minimize drainage into the nasal chamber with
its extensive absorption area. The hands should be washed immediately
following instillation.
4. Temporary discontinuance of medication is necessary if salivation,
urinary incontinence, diarrhea, profuse sweating, muscle weakness,
respiratory difficulties, or cardiac irregularities occur.
5. Patients receiving PHOSPHOLINE IODIDE who are exposed to
carbamate or organophosphate type insecticides and pesticides (professional
gardeners, farmers, workers in plants manufacturing or
formulating such products, etc.) should be warned of the additive
systemic effects possible from absorption of the pesticide through the
respiratory tract or skin. During periods of exposure to such pesticides,
the wearing of respiratory masks, and frequent washing and clothing
changes may be advisable.
6. Anticholinesterase drugs should be used with extreme caution, if at
all, in patients with marked vagotonia, bronchial asthma, spastic gastrointestinal
disturbances, peptic ulcer, pronounced bradycardia and
hypotension, recent myocardial infarction, epilepsy, parkinsonism, and
other disorders that may respond adversely to vagotonic effects.
7. Anticholinesterase drugs should be employed prior to ophthalmic
surgery only as a considered risk because of the possible occurrence,
of hyphema.
8. PHOSPHOLINE IODIDE should be used with great caution, if at
all, where there is a prior history of retinal detachment.
Adverse Reactions: 1. Although the relationship, if any, of retinal detachment
to the administration of PHOSPHOLINE IODIDE has not
been established, retinal detachment has been reported in a few cases
during the use of PHOSPHOLINE IODIDE in adult patients without a
previous history of this disorder.
2. Stinging, burning, lacrimation, lid muscle twitching, conjunctival
and ciliary redness, browache, induced myopia with visual blurring
may occur.
3. Activation of latent iritis or uveitis may occur.
4. Iris cysts may form, and if treatment is continued, may enlarge
and obscure vision. This occurrence is more frequent in children. The
cysts usually shrink upon discontinuance of the medication, reduction
in strength of the drops or frequency of instillation. Rarely, they may
rupture or break free into the aqueous. Regular examinations are advisable
when the drug is being prescribed for the treatment of
accommodative esotropia.
5. Prolonged use may cause conjunctival thickening, obstruction of
nasolacrimal canals.
6. Lens opacities occurring in patients under anticholinesterase
therapy have been reported; routine examinations should accompany
prolonged use.
7. Paradoxical increase in intraocular pressure may follow anticholinesterase
instillation. This may be alleviated by prescribing a
sympathomimetic mydriatic such as phenylephrine.
Overdosage: Antidotes are atropine, 2 mg parenterally; PROTOPAM*
CHLORIDE (pralidoxime chloride), 25 mg per kg intravenously;
artificial respiration should be given if necessary.
How Supplied: Four potencies are available. 15 mg package for dispensing
0.03% solution; 3.0 mg package for 0.06% solution; 6.25 mg
package for 0.125% solution; 12.5 mg package for 0.25% solution. Also
contains potassium acetate (sodium hydroxide or acetic acid may have
been incorporated to adjust pH during manufacturing), chlorobutanol
(chloral derivative), mannitol, boric acid and exsiccated sodium,
phosphate.
The Ophthalmos Division
AYERST LABORATORIES
New York, N.Y. 10017 7631

Page 22
Index to advertisers
Allergan Pharmaceuticals
Albalon : Second Cover
FML Fourth Cover
Ayerst Laboratories
Phospholine Iodide 12, 13, 14, 20, 21
Cambridge Instrument Company, Inc.
Electroretinograph 19
Frigitronics Company
2001 Cryoextractor 1
Muro Pharmacal Laboratories, Inc.
Gonio-Gel 17
Sodium Chloride 4
Topcon Instrument Corp. of America
SL-3 Slit Lamp 18
University of Iowa
Classified 6
University of Washington
Research Fellowships 6
Zeiss, Inc., Carl
Slit Lamp Accessory 2
While every precaution is taken to insure accuracy, we cannot guarantee against the possibility of an
occasional change or omission in the preparation of this index.

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Ophtluiliiin! 79:IOl:M7..|imc l inciting
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