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Ocular side effect of common systemic drugs.

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Ocular side effect of common systemic drugs.

  1. 1. OCULAR SIDE EFFECTS OF COMMON SYSTEMIC DRUGS DR.MALIHA NAWAR RESIDENT BANGABANDHU SHEIKH MUJIB MEDICAL UNIVERSITY DHAKA, BANGLADESH
  2. 2. Introduction:  Many systemic drugs have reported ocular and visual side effects that impact patient management. It is important to be familiar with the associated side effects which can be mild and transient or may seriously threaten vision. After a drug molecule enters the systemic circulation it can reach ocular tissues through uveal or retinal circulations. 2
  3. 3. Ocular Accumulation Sites: Three major accumulation sites: 1. Cornea 2. Lens 3. Vitreous The duration of drug in the eye is prolonged if deposited, increasing chance for toxicity. 3
  4. 4. Photosensitizers: The crystalline lens normally filters most ultra-violet UV radiation. UV radiation can potentially affect the retina in aphakic and pseudo phakic patients. Well-known photosensitizers that cause anterior subcapsular lens changes:- 1. Allopurinol 3. Amiodarone 2. Phenothiazine 4. Chloroquine 4
  5. 5. Digoxin (Cardiac Glycoside):  Used in AF , atrial flutter and congestive heart failure. Ocular side effects are common with high doses: Decreased vision to photopsia, xanthopsia and scotomas. Tetracyclines: Tetracycline - Minocycline- Doxycycline Ocular SE : Commonly, Pseudotumor cerebri All tetracycline agents are photosensitizers. 5
  6. 6. Ethambutol: A medications used to treat tuberculosis (TB) Ocular side effects: 1. Optic neuropathy 2. Retrobulbar neuritis resulting in blurred vision and loss of red- green vision 6
  7. 7. Amiodarone: Benzofuran derivative used to treat variety of cardiac abnormalities. Ocular side effects: 1. Vortex Keratopathy (corneal verticillata) 2. Anterior subcapsular cataract. 3. Amiodarone-Induced Optic Neuropathy (most severe SE) 7
  8. 8. Corticosteroids: At high doses (25-80 mg/d) for more than two years can lead to posterior subcapsular and nuclear cataract. Inhaled steroids associated with central serous choroidopathy. Macular detachment can occur in susceptible individual. In patients who are steroid responders, oral steroids induces increase in IOP. 8
  9. 9. Aminoquinolines: Chloroquine and hydroxychloroquine are antimalarial drugs used to treat rheumatoid arthritis, SLE, and other collagen diseases. Ocular SE: 1. Corneal opacities 2. Decrease in corneal sensation 3. Decrease accommodation 4. Posterior Subcapsular Cataract. 5. Relative VF defects 9
  10. 10. Phenothiazines: Thioridazine and Chlorpromazine are psychotropic agents used to manage depression with anxiety and other behavioral conditions. Ocular side effects may include:- 1. Nyctalopia 2. Brown vision 3. Decreased vision 4. Salt/pepper retinopathy leading to widespread loss of RPE and choriocapillaris 10
  11. 11. Tamoxifen Citrate Nonsteroidal antiestrogen agent , is one of the most effective antitumor treatments of metastatic breast carcinoma in postmenopausal women Causes crystalline retinopathy  Retinal toxicity.  Macular edema and impaired visual acuity. 11
  12. 12. Antiseizure Agents: Topiramate: Also prescribed off label for migraine headaches Syndrome observed: 1. Acute myopia 2. Secondary angle closure glaucoma due to anterior chamber shallowing. Gabapentin 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 12
  13. 13. Allergy Medications: Cetirizine and Loratadine has weak atropine-like action;  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 13
  14. 14. Tamsulosin hydrochloride: Selective Systemic Alpha-1 antagonist, used for BPH. Ocular SE: Intraoperative Floppy Iris Syndrome (IFIS) Synthetic Thyroid Agents: Levothyroxine Ocular SE: Pseudotumor cerebri in pre- & peri puberty hypothyroid children 14
  15. 15. Anti-Coagulants: Warfarin Ocular SE: 1. Subconjunctival hemorrhage 2. Retinal hemorrhage 3. AMD 15
  16. 16. Antidepressant Agents: Fluoxetine hydrochloride (SSRI):used to treat depression, OCD, bulimia. Sertraline has same indications. Ocular SE: 1. Mydriasis, 2. Photophobia, 3. K sicca, conjunctivitis, 4. Diplopia, ptosis 16
  17. 17. Radiation for malignancy therapy: Targets cellular DNA-kills abnormal and normal cells. Ocular SE: 1. Trichiasis, epiphora, ectropion, 2. Dry eye (61% of patients) 3. Cataract, 4. Uveitis, Robeosis irides 5. Radiation Retinopathy 6. Radiation Optic Neuropathy 17
  18. 18. To Sum Up: The ocular and visual side effects from a patient’s systemic medication can range from mild to severe. These side effects may or may not be serious enough to warrant discontinuing treatment. Recognition of ocular and visual side effects is important for prompt management to prevent and minimize serious complications. Familiarity with medications improves by routinely paying attention to concomitant medications. 18
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