Allopurinol
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Meige syndrome-like blepharospasm: case report A 51-year-old man developed Meige syndrome-like blepharospasm while receiving allopurinol for uric acid nephropathy. The man had a history of gout for 3 years. Based on further investigations, he was diagnosed with gout and uric acid nephropathy, with stage 3 chronic kidney disease. Initially, oral allopurinol tablets, 100mg per tablet was administered twice daily (one tablet each time). One week later, he presented with blurred vision. His allopurinol treatment was discontinued. Ophthalmic examination demonstrated mild conjunctival congestion of the right eye, normal cornea of both eyes, equal pupil size and no significant changes in refractive media and ocular fundus of both eyes. A diagnosis of chronic conjunctivitis with ametropia was considered. Sulfacetamide [sulfacetamide sodium] eye drops and diclofenac [diclofenac sodium] eye drops as well as glasses were prescribed. Thereafter, condition of blurred vision improved. Three days later, he re-initiated and continued oral allopurinol. However, he developed symptoms in both eyes, including difficulty in eye-opening, photophobia, tearing, blepharospasm with no muscle spasm of jaw and mouth. Despite having normal CNS and facial sensory examinations, both eyes could not be completely opened with force. He had orbicularis muscle contraction and paroxysmal tics of the upper and lower eyelids. Mecobalamin tablets, artificial tears, fibroblast growth factor [recombinant bovine basic fibroblast growth factor] and ofloxacin eye drops were prescribed for symptomatic management. The symptoms continued to persist. Diagnosis of Meige syndrome-like blepharospasm was considered secondary to allopurinol. Fifteen days later, the man received botulinum toxin A injections into eyelids. One day later, the difficulty in eye-opening was improved, and he could open the eyelids himself, but only for a few seconds. No additional treatment was given, and he was discharged. The symptoms gradually resolved, and he could open his eyes three months later. Facial nerve and axillary nerve electromyography (EMG) and chest CT examination were taken during this period, and the results were found to be normal. Possibilities of thymoma and myasthenia gravis were excluded. The spasm disappeared and normal eye function was restored after six months. LaiMin L. A case report of Meige syndrome-like blepharospasm caused by ingestion of allopurinol. Pakistan Journal of Pharmaceutical Sciences 33: 1707-1709, No. 4, Jul 803503794 2020. Available from: URL: http://www.pjps.pk/previous-issues/
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Reactions 26 Sep 2020 No. 1823
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