drugs with adverse ocular effects

Introduction

Includes:

• alpha-1 adrenergic receptor antagonists (alpha-blockers)
  • blurred vision
  • eye pain
  • floppy-iris syndrome (most frequent with tamsulosin)
• amiodarone (Cordarone)
  • corneal deposits
    • occur in ~70% of patients on amiodarone
    • may result in vision loss
  • optic neuritis
  • optic neuropathy
  • optic neuropathy &/or neuritis may occur any time after starting amiodarone (2% of patients on amiodarone) visual impairment & blindness can result
  • photosensitivity
  • patients taking amiodarone should have a baseline eye exam & eye exams every s6-12 months
  • patients should call provider if visual disturbances
• bisphosphonates
  • blurred vision
  • conjunctivitis
  • episcleritis
  • eye pain
  • iritis
  • scleritis
  • uveitis
  • ocular adverse effects are associated with inflammation, possibly immunologic in nature
  • may be seen within 48 hours after starting pamidronate
  • may be seen two days to 2 weeks after starting alendronate
  • stopping bisphosphonate may resolve ocular adverse effects
• canthaxanthin
  • altered eye function
  • decreased visual acuity
  • retinal deposits
  • reaction is dose-related
  • symptoms are reversible
  • patients are frequently asymptomatic
• celecoxib (Celebrex)
  • blurred vision
  • cataracts
  • conjunctivitis
  • conjunctival hemorrhage
  • eye pain
  • glaucoma
  • vitreous floaters
  • adverse effects might be caused by alteration of retinal blood flow &/or inflammation resulting from secretion of the medication in tears
  • stopping celecoxib should resolve most ocular side effects within 72 hours
• chloroquine (Aralen), hydroxychloroquine (Plaquenil)
  • blurred vision
  • contact lens intolerance
  • corneal deposits
  • retinopathy
  • dose-related, occurs with long-term therapy
  • retinal changes & visual disturbances may progress after drug is stopped
  • baseline & eye exams every 3-6 months
  • discontinue for any visual disturbances
• corticosteroids
  • cataracts
  • glaucoma
  • optic neuritis
  • retinopathy
  • risk associated with prolonged use of inhaled, oral, or topical corticosteroids
  • taper ASAP if intraocular pressure increases
• digoxin
  • visual disturbances
  • reduced visual acuity
  • visual symptoms can occur with therapeutic levels of digoxin
  • symptoms can resolve with correction of supratherapeutic levels or with discontinuation of digoxin
• ethambutol (Myambutol, Etibi)
  • color vision changes
  • optic neuropathy
    • may be related to dose and duration of treatment
    • generally reversible when ethambutol is stopped
    • may continue to progress for 1-2 months after discontinuation
    • recovery may be delayed for > 1 year
    • irreversible blindness has been reported
  • visual field defects
  • eye exams at baseline & periodically thereafter
    • patients on > 15 mg/kg/day should have monthly eye exams
  • notify provider of any vision changes
• isoniazid
  • optic neuropathy, usually reversible & less severe than with ethambutol
• isotretinoin (Accutane), vitamin A1
  • cataracts
  • conjunctivitis
  • corneal opacities
    • dose-related & resolve in a couple of months after therapy is stopped
  • decreased night vision may persist after therapy is stopped
  • pseudotumor cerebri (intracranial hypertension)
  • papilledema
  • photophobia
  • reduced tolerance to contact lenses
  • visual changes are dose related
  • stop retinoid if any visual difficulties or headaches, with eye exam to rule out papilledema secondary to intracranial hypertension
  • periodic eye exams if oral retinoid therapy for >= 6 months
• linezolid (Zyvox, Zyvoxam)
  • optic neuropathy
    • decreased vision & color vision, visual field defects
  • reported cases occurred after 5-11 months of therapy
  • symptoms improve after discontinuation
  • eye exam if treatment for >= 3 months
• niacin (Niaspan)
  • cystoid macular edema
    • usually resolves within 2 weeks after stopping niacin
  • decreased vision
  • dry eyes
• phenothiazines
  • cataracts
    • dose & drug dependent
    • most common with chlorpromazine & thioridazine
  • retinopathy
    • may develop within weeks-months with high-dose thioridazine
    • blurred vision is usually the initial symptom
• phosphodiesterase-5 inhibitors
  • blurred vision
  • cataracts
  • changes in color perception
  • conjunctivitis
  • dry eyes
  • eye hemorrhage
  • eye pain
  • mydriasis
  • non-arteritic anterior ischemic optic neuropathy
    • may result in decreased vision or permanent vision loss
    • causality of PDE5 inhibitors has not been established
  • photophobia
  • ocular adverse effects are dose-dependent
  • PDE5 inhibitors should not be used in patients with hereditary degenerative retinal disorders
  • stop PDE5 inhibitor & call provider if vision loss
• tamoxifen (Nolvadex)
  • cataracts, slow blurring of vision
  • corneal opacities
  • decreased color vision perception
  • retinal vein thrombosis
  • retinopathy
    • commonly occurs after > 1 year of therapy when a total of > 100 gm has been administered
    • an acute, reversible retinopathy can also develop within weeks of starting therapy
  • patients should have an eye exam at baseline & every 2 years
  • call provider for any ocular adverse effects
• telithromycin (Ketek)
  • blurred vision
  • difficulty focusing
  • double vision
  • visual adverse events in ~ 2% of patients
  • most visual adverse events occur following the 1st or 2nd dose
  • visual adverse events may last several hours & recur with subsequent doses in some patients
  • symptoms may resolve or continue with continued administration
  • women < 40 years are most likely to experience adverse visual events
  • call provider for any vision problems
• tiagabine (Gabitril)
  • abnormal vision
  • deteriorating color vision
  • mechanism may be retinal toxicity from elevated levels of GABA
• topiramate (Topamax)
  • acute angle-closure glaucoma
    • blurred vision, eye pain, headache, nausea, vomiting
    • pressure may return to normal in hours to days when tiagabine is stopped
  • acute myopia, may take weeks to resolve
  • increased ocular pressure
    • may occur within one month of therapy, & within hours after doubling the dose
  • mydriasis
  • call provider for blurred vision, visual disturbances, or eye pain
• vigabatrin (Sabril)-Canada only
  • optic atrophy
  • optic neuritis
  • peripheral constriction of visual field
    • occurs in ~ 30% of patients
    • usually occurs in the first 4 years of treatment
  • mechanism may be retinal toxicity from elevated levels of GABA
  • visual field defects are likely permanent even after stopping vigabatrin
  • visual field examinations before or soon after starting vigabatrin are recommended, then every 3 months thereafter
• voriconazole (Vfend)
  • optic neuritis
  • papilledema
  • ocular adverse effects have occurred mainly in severely ill patients
  • if administration > 28 days, visual function should be monitored

More general terms

• drug-induced eye disease

More specific terms

• drugs that require eye exam

Additional terms

• pharmaceutical herbs with adverse ocular effects