Ocular Effects of Systemic Medications - #27
Take QuizIdentify and manage ophthalmic complications of systemic medications.
| Drug Class | Examples of common drugs | Condition | Eye Effects | Contraindications |
|---|---|---|---|---|
| α1-adrenergic blockers | Doxazosin Tamsulosin, Terazosin | Benign prostatic hyperplasia | Intraoperative floppy iris syndrome (IFIS) 1 | Surgeon must be aware before patients undergo cataract surgery 1 |
| Antiarrhythmics | Amiodarone | Cardiac arrhythmias | Colored rings or halos in visual fields; loss of lashes/eyebrows; yellow-brown deposits in conjunctiva; optic neuropathy; keratopathy; photosensitivity 1-4 | |
| Anticholinergics | Oxybutynin, Solifenacin, Tolterodine | Overactive bladder, urinary urge incontinence | Acute angle closure glaucoma 5 | Anatomically narrow angles, untreated closed angle glaucoma 5 |
| Anticonvulsant | Topiramate | Seizures, migraines | Transient myopia; acute secondary angle-closure glaucoma; blurred vision; increased intraocular pressure; nystagmus 1-3 | |
| Anti-estrogen therapy | Tamoxifen | Estrogen receptor positive breast cancer | Keratopathy; posterior subcapsular cataracts; crystalline retinopathy 1,2,4 | |
| Anti- gamma-aminobutyric acid (GABA)transaminase | Vigabatrin | Seizures | Bilateral peripheral visual field constriction; acute angle closure glaucoma 1,4 | |
| Antihistamines | Cetirizine Chlorpheniramine, Diphenhydramine, Loratadine | Allergies | Dry eyes; decreased vision; pupillary changes; lacrimation 3 | |
| Antimalarials | Aminoquino-lines, Chloroquine, Hydroxychloroquine | Malaria, rheumatoid artdritis, lupus | Keratopathy; retinopathy 1,4 | |
| Antioxidant | Ginkgo biloba | Dementia | Spontaneous hyphema; retinal hemorrhages 2,3 | Use with caution in patients taking aspirin and warfarin 2 |
| Antituberculosis therapy | Ethambutol, Isoniazid | Tuberculosis | Toxic optic neuropathy 2 | |
| Antiviral | Amantadine | Influenza A | Keratopathy; corneal edema 6 | |
| Bisphosphonates | Alendronate, Etidronate Pamidronate, Risedronate, | Osteoporosis, Paget's disease of bone | Pain; photophobia; blurred vision; conjunctivitis; uveitis; episcleritis/scleritis; ptosis; nerve palsies 2 | |
| COX-2 inhibitors | Celecoxib, Rofecoxib, Valdecoxib | Arthritis, acute pain | Blurred vision; conjunctivitis 2 | |
| Corticosteroids | Cortisone, Dexametdasone, Hydrocortisone, Prednisone | Inflammatory disorders | Posterior subcapsular cataracts; increased intraocular pressure in susceptible individuals; immunosuppression leading to infectious complications; decreased vision; mydriasis; photophobia 1-3 | |
| HMG-CoA Reductase Inhibitor | Atorvastatin, Fluvastatin, Lovastatin, Pravastatin, Rosuvastatin, Simvastatin | Hyperlipidemia | Diplopia; ptosis; ophthalmoplegia; localized myositis in orbital muscles 2 | |
| Phosphodiesterase-5 Enzyme ( PDE5) inhibitors | Sildenafil, Tadalafil, Vardenafil, | Erectile dysfunction | Bluish tinge/haze to vision; light sensitivity; blurred vision; conjunctival hyperemia; ocular pain 1-3 | Pilots should not use within 6 hours of performing duties; avoid in patients with nonarteritic anterior ischemic optic neuropathy 1 |
| Retinoic Acid Derivative | Isotretinoin | Acne, psoriasis | Blepharoconjunctivitis; dry eyes; transient blurred vision; myopic shifts; decreased night vision; keratitis; corneal opacities; photosensitivity; papilledema 3,4 | Not for use in pregnancy |
| Sphingosine 1-Phosphate (S1P) Receptor Modulator | Fingolimod | Multiple sclerosis | Cystoid macular edema 7 | |
| thiazolidinedione | Pioglitazone, Rosiglitazone | Diabetes | May increase risk of diabetic macular edema 8 | |
| Tricyclic antidepressants | Amitriptyline, Imipramine | Depression | Blurred vision; mydriasis; dry eyes; photosensitivity; cycloplegia; blepharospasm 3,4 | |
| Vitamin | Niacin | Hyperlipidemia | Cystoid macular edema; dry eyes; discoloration of eyelids; eyelid edema 2 |
Geriatric inpatients and outpatients seen by an eye care provider.
Identifying systemic medications as the etiology of ocular signs and symptoms in a geriatric patient.
Systemic medications can have adverse eye effects: ranging from mild to severe (e.g., dry eye syndrome to sight threatening optic neuropathy). Geriatric patients are particularly susceptible because they are more likely to: (1) require medication(s) for prolonged duration and (2) have difficulty with metabolism and excretion of drugs. Adverse events can occur at any time during a course of medication and can continue after cessation.
Science Principles
To identify and manage ophthalmic complications of systemic medications commonly used in geriatric patients.(1)
Review of Systems (ROS)
Geriatric Topics
ACGME Compentencies
Science Principles
- Blomquist PH. Ocular Complications of Systemic Medications. Am J Med Sci 2011;342(1):62-9.
- Santaella RM, Fraunfelder FW. Ocular Adverse Effects Associated with Systemic Medications: Recognition and Management. Drugs 2007;67(1):75-93.
- Jaanus S. Ocular Effects Associated with Medications. Science and Medicine 2006.
- Izazola-Conde C, Zamora-de la Cruz D, Tenorio-Guajardo G. Ocular and Systemic Adverse Effects of Ophthalmic and Non Ophthalmic Medications. Proc West Pharmacol Soc 2011;54:69-72.
- Gani J, Perlis N, Radomski SB. Urologic Medications and Ophthalmologic Side Effects: A Review. Can Urol Assoc J. 2012;6(1):53-8.
- Chang KC, Jeong JH, Kim MK, et al. The Effect of Amantadine on Corneal Endothelium in Subjects with Parkinson’s Disease. Ophthalmology 2010;117:1214-9.
- Jain N, Bhatti MT. Fingolimod-Associated Macular Edema: Incidence, Detection, and Management. Neurology 2012;78(9):672-80.
- Idris I, Warren G, Donnelly R. Association Between Thiazolidinedione Treatment and Risk of Macular Edema Among Patients with Type 2 Diabetes. Arch Intern Med 2012; 172(13):1005-11.
Users are free to download and distribute Geriatric Fast Facts for informational, educational, and research purposes only. Citation: Kathryn Barbieri, Cristin Subramanian MD, Jonathan Skarie MD, Bhavna Sheth MD, Edmund Duthie MD, Fast Fact #27: Ocular Effects of Systemic Medications, November 2012.
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