Topical pharmacologic agents such as cocaine, phenylephrine, apraclonidine, or hydroxyamphetamine
can be used to confirm a diagnosis of HS. Cocaine acts by blocking the reuptake of norepinephrine in the neuromuscular junction of the iris dilator muscle, causing the pupil in a normal eye to dilate, while incomplete dilation is seen in HS.,
(12) Cocaine and hydroxyamphetamine
are not readily available in Australia; however, phenylephrine has been used in birds and apraclonidine has been suggested as a more-accessible alternative.
drops have historically been used to distinguish preganglionic from postganglionic disease.
methamphetamine, and hydroxyamphetamine derivatives in urine by gas
The presence of hydroxyamphetamines in hair is commonly viewed as
It is worth noting that the hydroxyamphetamines are structurally
(8) 10 grams or more of other dangerous drugs such as, but not limited to, methylenedioxymethamphetamine (MDA) or 'ecstasy,' paramethoxyamphetamine (PMA), trimethoxyamphetamine (TMA), lysergic acid diethylamine (LSD), gamma hydroxyamphetamine
(GHB) and those similarly designed or newly introduced drugs and their derivatives, without having any therapeutic value or if the quantity possessed is far beyond therapeutic requirements, as determined and promulgated by the Board in accordance with Section 93, Article XI of this Act.
Topical cocaine and hydroxyamphetamine
were also previously used in the diagnosis of HS as pharmacological testing.10,11 Recently, aproclonidine is another drug commonly used to diagnose the HS due to its cost and ease availability.11,12
Thompson and Mensher (1) described the topical use of cocaine to confirm the diagnosis of Horner's syndrome and hydroxyamphetamine to distinguish between pre- and postganglionic causative lesions.
Unfortunately, the cocaine test has drawbacks: (i) some clinicians find it difficult to obtain the drug owing to its scheduling status, and in some countries it is not available at all; (ii) cocaine inhibits the uptake of hydroxyamphetamine from the nerve terminal and the two tests therefore cannot be conducted on the same day; (iii) metabolites of cocaine may remain in urine for up to 2 days after an ophthalmological test, which has implications for patients who may be subjected to a drug-screening test of their urine; (5) (iv) sensitivity of the test is reduced in cases where the interruption of the sympathetic pathway is incomplete; and (v) the response in patients with dark irides may be extremely slow, and up to 3 hours should be allowed before interpreting the results.
Food and Drug Administration approved Paremyd eye drops which contain hydroxyamphetamine
) because of degeneration of the sympathetic terminals in the iris dilator muscle, whereas in fact the response to such agents has been shown to be normal [23, 24] in elderly subjects.