Hematinic deficiencies can cause anemia, which is also associated with aphthous-like ulceration.Gastrointestinal disorders are sometimes associated with aphthous-like stomatitis, e.g. most commonly celiac disease, but also inflammatory bowel disease such as Crohns disease or ulcerative colitis. The link between gastrointestinal disorders and aphthous stomatitis is probably related to nutritional deficiencies caused by malabsorption. Less than 5% of people with RAS have celiac disease, which usually presents with severe malnutrition, anemia, abdominal pain, diarrhea and glossitis (inflammation of the tongue). Sometimes aphthous-like ulcerations can be the only sign of celiac disease. Despite this association, a gluten-free diet does not usually improve the oral ulceration.Other examples of systemic conditions associated with aphthous-like ulceration include reactive arthritis, and recurrent erythema multiforme. Diagnosis
Diagnosis is mostly based on the clinical appearance and the medical history. The most important diagnostic feature is a history of recurrent, self healing ulcers at fairly regular intervals. Although there are many causes of oral ulceration, recurrent oral ulceration has relatively few causes, most commonly aphthous stomatitis, but rarely Behçets disease, erythema multiforme, ulceration associated with gastrointestinal disease, and recurrent intra-oral herpes simplex infection. A systemic cause is more likely in adults who suddenly develop recurrent oral ulceration with no prior history.Special investigations may be indicated to rule out other causes of oral ulceration. These include blood tests to exclude anemia, deficiencies of iron, folate or vitamin B12, or celiac disease. However, the nutritional deficiencies may be latent and the peripheral blood picture may appear relatively normal.
Tobramycin/dexamethasone, sold under the brand name Tobradex, is a fixed-dose combination medication in the form of eye drops and eye ointment, marketed by Alcon. The active ingredients are tobramycin (an antibiotic) and dexamethasone (a corticosteroid). It is prescribed for the treatment of pink eye in combination with bacterial infections. Contraindications
It is contraindicated with herpetic and other viral eye infections. Other contraindications include fungal and mycobacterial infections because tobramycin is inactive against those, and the corticoid acts as an immunosuppressive agent, preventing the bodys immune system from dealing with the infection. The drops are also contraindicated in patients with corneal lesions. Side effects
Similarly to other corticosteroid eye drops, side effects include hypersensitivity and, especially after long-term use, secondary eye infections, cataract (clouding of the eye lens) and increased intraocular pressure, leading to glaucoma. Consequently, the drug should not be applied longer than 24 days without further medical evaluation. Interactions
Anticholinergic eye drops potentiate the risk of increased intraocular pressure. Systemic aminoglycoside antibiotics increase toxicity for ears, nerves and kidney. Brand names
Tobrason is a brand name in Jordan. References
External links
"Dexamethasone mixture with tobramycin". Drug Information Portal. U.S. National Library of Medicine.