OCULAR SIDE EFFECTS OF
COMMON SYSTEMIC DRUGS
BANGABANDHU SHEIKH MUJIB MEDICAL UNIVERSITY
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.
Ocular Accumulation Sites:
Three major accumulation sites:
The duration of drug in the eye is prolonged if deposited,
increasing chance for toxicity.
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
1. Allopurinol 3. Amiodarone
2. Phenothiazine 4. Chloroquine
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.
Tetracycline - Minocycline- Doxycycline
Ocular SE : Commonly, Pseudotumor cerebri
All tetracycline agents are photosensitizers.
A medications used to treat tuberculosis (TB)
Ocular side effects:
1. Optic neuropathy
2. Retrobulbar neuritis resulting in blurred vision and loss of red-
Benzofuran derivative used to treat variety of cardiac
Ocular side effects:
1. Vortex Keratopathy (corneal verticillata)
2. Anterior subcapsular cataract.
3. Amiodarone-Induced Optic Neuropathy (most severe SE)
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.
Chloroquine and hydroxychloroquine are antimalarial drugs used
to treat rheumatoid arthritis, SLE, and other collagen diseases.
1. Corneal opacities
2. Decrease in corneal sensation
3. Decrease accommodation
4. Posterior Subcapsular Cataract.
5. Relative VF defects
Thioridazine and Chlorpromazine are psychotropic agents used to
manage depression with anxiety and other behavioral conditions.
Ocular side effects may include:-
2. Brown vision
3. Decreased vision
4. Salt/pepper retinopathy leading to widespread loss of RPE and
Nonsteroidal antiestrogen agent , is one of the most effective
antitumor treatments of metastatic breast carcinoma in
Causes crystalline retinopathy
Macular edema and impaired visual acuity.
Topiramate: Also prescribed off label for migraine headaches
1. Acute myopia
2. Secondary angle closure glaucoma due to anterior chamber
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
Cetirizine and Loratadine has weak atropine-like action;
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
Selective Systemic Alpha-1 antagonist, used for BPH.
Intraoperative Floppy Iris Syndrome (IFIS)
Synthetic Thyroid Agents:
Ocular SE: Pseudotumor cerebri in pre- & peri puberty
Fluoxetine hydrochloride (SSRI):used to treat depression, OCD,
Sertraline has same indications.
3. K sicca, conjunctivitis,
4. Diplopia, ptosis
Radiation for malignancy
Targets cellular DNA-kills abnormal and normal cells.
1. Trichiasis, epiphora, ectropion,
2. Dry eye (61% of patients)
4. Uveitis, Robeosis irides
5. Radiation Retinopathy
6. Radiation Optic Neuropathy
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
Recognition of ocular and visual side effects is important for
prompt management to prevent and minimize serious
Familiarity with medications improves by routinely paying
attention to concomitant medications.