Ocular Side Effects of Systemic Medications



Ocular Side Effects of Systemic Medications





Ocular Side Effects of Systemic Medications

Bruce E. Onofrey

Tonya G. Ketcham

Systemic medications have the potential, under certain circumstances, to produce undesirable adverse effects in all tissues of the body, including the eyes. Drug toxicity, which is heavily researched in clinical trials before the drugs are released, is not an infrequent occurrence.

However, ocular adverse reactions are often overlooked, misdiagnosed, or go unrecognized in clinical trials, and hence are severely underreported. Ocular side effects are often discovered after the drug has been released to the public. Currently, in the literature, over 75 specific drugs and, in some cases, classes of drugs have been linked with ocular side effects. The following tables will illustrate some of the more notable drug-eye interactions (Tables 4-1, 4-2, 4-3, 4-4, 4-5, 4-6, 4-7, 4-8, 4-9, 4-10, 4-11 and 4-12).








TABLE 4-1 Drugs that Cause Miscellaneous Ocular/Visual Disturbances



































































































Drug class or drug

Complications


Acetazolamide

Transient myopia, ocular paresthesia


Anticonvulsants

Acute myopia (6-8 D), glare, diplopia, visual hallucinations, color vision changes, nystagmus, night blindness, scotomas, extraocular muscle paresis, reduced contrast sensitivity


Antihistamines

Anisocoria, decreased accommodation, nystagmus, diplopia


Antipsychotics

Cycloplegia, diplopia, photophobia, ptosis, ocular pain


Antiulcer agents

Myopia, yellow-pink tinge to vision, visual hallucinations


Atorvastatin

Ocular myasthenia


Benzodiazepines

Decreased corneal reflex, decreased death perception, extraocular muscle paresis, mydriasis


Barbiturates

Ptosis, extraocular muscle paresis, nystagmus, color vision changes


β-Blockers

Diplopia, visual hallucinations, worsen ocular myasthenia


Cidofovir

Decreased intraocular pressure, ocular hypotony


Cisplatin

Decreased vision, scotomas


Corticosteroids

Diplopia, mydriasis, color vision changes, visual field loss


Digitalis

Color vision changes, flickering vision, mydriasis, halos


Erectile dysfunction agents

Color vision changes, photophobia, flashing lights, bluish tinge to visual field, changes in brightness perception, hazy vision, ERG changes, ocular pain, mydriasis


Gold salts

Nystagmus, color vision changes, photophobia, diplopia


Hydrochlorothiazide

Myopic shift


Ibuprofen

Refractive error changes, color vision changes, central scotoma


Isotretinoin

Photophobia, decreased dark adaptation (permanent), myopia


Levothyroxine

Visual hallucinations


Lithium

Blurred vision (cortical), downbeat jerk nystagmus, diplopia, accommodative dysfunction


Metronidazole

Refractive error changes


Methylphenidate

Accommodative dysfunction, visual hallucinations, mydriasis


Quinolones

Decreased vision, flashing lights, overbrightness of lights, color vision changes, diplopia, nystagmus, eye pain


Regular insulin

Decreased vision, nystagmus, extraocular muscle paresis, diplopia


Selective serotonin reuptake inhibitors (SSRIs)

Diplopia, increased extraocular movements, accommodative dysfunction


Statins

Blepharoptosis, diplopia, ophthalmoplegia


Sulfonamides

Myopic shift secondary to ciliary body edema


Tamsulosin

Intraoperative floppy iris syndrome; significantly increase risks at the time of cataract surgery (sight-threatening complications)


Tetracyclines

Decreased vision, photophobia, diplopia, myopia


Topiramate

Nystagmus, diplopia, blurred vision, myopic shift


Vigabatrin

Irreversible visual field constriction, abnormal color vision










TABLE 4-2 Drugs that Cause Ocular Surface Disease and Related Manifestations




























































Drug class or drug

Ocular surface complications


Amiodarone

Blepharoconjunctivitis, conjunctiva pigmentation, aggravate dry eye


Anticholinergics

Dry eye


Antihistamines

Severe aqueous-deficient dry eye, decrease mucin layer of tears


Antipsychotics

Reduced tearing, dry eye, blue conjunctiva, conjunctivitis


β-Blockers

Decreased tear secretion, dry eye


Erectile dysfunction agents

Conjunctivitis, dry eye


Estrogens/progestin

Reduced tear secretion, dry eye, contact lens intolerance


Hydrochlorothiazide

Changes tear film levels causing dry eye


Isotretinoin

Blepharoconjunctivitis, dry eye, keratitis, meibomian gland atrophy


Levothyroxine

Eyelid hyperemia, conjunctivitis


Lithium

Dry eye


Methotrexate

Aggravates seborrheic blepharitis: ocular irritation, photophobia, epiphora, periorbital edema, conjunctival hyperemia


Nalidixic acid

Dry eye, eyelid edema, conjunctiva hyperemia


Quinolones

Increased lacrimation, conjunctivitis


Salicylates

Conjunctivitis, blepharoconjunctivitis


SSRI

Eyelid changes, dry eye, conjunctivitis


Sulfonamides

Conjunctivitis, blepharoconjunctivitis


Tricyclic antidepressants

Dry eye

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Jul 21, 2016 | Posted by in OPHTHALMOLOGY | Comments Off on Ocular Side Effects of Systemic Medications

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