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:
 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.
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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.
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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
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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.
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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
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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)
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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.
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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
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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
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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.
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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
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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
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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
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15. Anti-Coagulants:
Warfarin
Ocular SE:
1. Subconjunctival hemorrhage
2. Retinal hemorrhage
3. AMD
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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
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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
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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.
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