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Ocular side effect of common systemic drugs.
1. OCULAR SIDE EFFECTS OF
COMMON SYSTEMIC DRUGS
DR.MALIHA NAWAR
RESIDENT
BANGABANDHU SHEIKH MUJIB MEDICAL UNIVERSITY
DHAKA, BANGLADESH
2. Introduction:
ď Many systemic drugs have reported ocular and visual side effects
that impact patient management.
ďIt is important to be familiar with the associated side effects which
can be mild and transient or may seriously threaten vision.
ďAfter a drug molecule enters the systemic circulation it can reach
ocular tissues through uveal or retinal circulations.
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3. Ocular Accumulation Sites:
ďThree major accumulation sites:
1. Cornea
2. Lens
3. Vitreous
The duration of drug in the eye is prolonged if deposited,
increasing chance for toxicity.
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4. Photosensitizers:
ďThe crystalline lens normally filters most ultra-violet UV radiation.
ďUV radiation can potentially affect the retina in aphakic and
pseudo phakic patients.
ďWell-known photosensitizers that cause anterior subcapsular lens
changes:-
1. Allopurinol 3. Amiodarone
2. Phenothiazine 4. Chloroquine
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5. Digoxin (Cardiac Glycoside):
ď Used in AF , atrial flutter and congestive heart failure.
ďOcular side effects are common with high doses: Decreased vision
to photopsia, xanthopsia and scotomas.
Tetracyclines:
ďTetracycline - Minocycline- Doxycycline
ďOcular SE : Commonly, Pseudotumor cerebri
ďAll tetracycline agents are photosensitizers.
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6. Ethambutol:
ďA medications used to treat tuberculosis (TB)
ďOcular side effects:
1. Optic neuropathy
2. Retrobulbar neuritis resulting in blurred vision and loss of red-
green vision
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7. Amiodarone:
ďBenzofuran derivative used to treat variety of cardiac
abnormalities.
ďOcular side effects:
1. Vortex Keratopathy (corneal verticillata)
2. Anterior subcapsular cataract.
3. Amiodarone-Induced Optic Neuropathy (most severe SE)
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8. Corticosteroids:
ďAt high doses (25-80 mg/d) for more than two years can lead to
posterior subcapsular and nuclear cataract.
ďInhaled steroids associated with central serous choroidopathy.
Macular detachment can occur in susceptible individual.
ďIn patients who are steroid responders, oral steroids induces
increase in IOP.
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9. Aminoquinolines:
ďChloroquine and hydroxychloroquine are antimalarial drugs used
to treat rheumatoid arthritis, SLE, and other collagen diseases.
ďOcular SE:
1. Corneal opacities
2. Decrease in corneal sensation
3. Decrease accommodation
4. Posterior Subcapsular Cataract.
5. Relative VF defects
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10. Phenothiazines:
ďThioridazine and Chlorpromazine are psychotropic agents used to
manage depression with anxiety and other behavioral conditions.
ďOcular side effects may include:-
1. Nyctalopia
2. Brown vision
3. Decreased vision
4. Salt/pepper retinopathy leading to widespread loss of RPE and
choriocapillaris
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11. Tamoxifen Citrate
ďNonsteroidal antiestrogen agent , is one of the most effective
antitumor treatments of metastatic breast carcinoma in
postmenopausal women
ďCauses crystalline retinopathy
ď Retinal toxicity.
ď Macular edema and impaired visual acuity.
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12. Antiseizure Agents:
ďTopiramate: Also prescribed off label for migraine headaches
ďSyndrome observed:
1. Acute myopia
2. Secondary angle closure glaucoma due to anterior chamber
shallowing.
ďGabapentin antiepileptic: used also for post-herpetic neuralgia
and neuropathic pain
1. Nystagmus in 8% & Diplopia in 6%
2. Macular edema, Optic neuritis and VF defects
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13. Allergy Medications:
ďCetirizine and Loratadine has weak atropine-like action;
ď Ocular SE:
1. Decreased accommodation,
2. Blurred vision
3. Decreased mucoid and lacrimal secretion
4. Can induce mydriasis and provoke IOP elevation
5. Large doses can cause facial dyskinesia or blepharospasm
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14. Tamsulosin hydrochloride:
ďSelective Systemic Alpha-1 antagonist, used for BPH.
ďOcular SE:
ďIntraoperative Floppy Iris Syndrome (IFIS)
Synthetic Thyroid Agents:
ďLevothyroxine
ďOcular SE: Pseudotumor cerebri in pre- & peri puberty
hypothyroid children
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16. Antidepressant Agents:
ďFluoxetine hydrochloride (SSRI):used to treat depression, OCD,
bulimia.
ďSertraline has same indications.
ďOcular SE:
1. Mydriasis,
2. Photophobia,
3. K sicca, conjunctivitis,
4. Diplopia, ptosis
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17. Radiation for malignancy
therapy:
ďTargets cellular DNA-kills abnormal and normal cells.
ďOcular SE:
1. Trichiasis, epiphora, ectropion,
2. Dry eye (61% of patients)
3. Cataract,
4. Uveitis, Robeosis irides
5. Radiation Retinopathy
6. Radiation Optic Neuropathy
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18. To Sum Up:
ďThe ocular and visual side effects from a patientâs systemic
medication can range from mild to severe.
ďThese side effects may or may not be serious enough to warrant
discontinuing treatment.
ďRecognition of ocular and visual side effects is important for
prompt management to prevent and minimize serious
complications.
ďFamiliarity with medications improves by routinely paying
attention to concomitant medications.
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