drugs that require eye exam

Includes: 1) amiodarone (Cordarone) a) corneal deposits 1] occur in ~70% of patients on amiodarone 2] may result in vision loss b) optic neuritis c) optic neuropathy d) optic neuropathy &/or neuritis may occur any time after starting amiodarone (2% of patients on amiodarone) visual impairment & blindness can result e) photosensitivity f) patients taking amiodarone should have a baseline eye exam & eye exams every 6-12 months g) patients should call provider if visual disturbances 2) chloroquine (Aralen), hydroxychloroquine (Plaquenil) a) blurred vision b) contact lens intolerance c) corneal deposits d) retinopathy e) dose-related, occurs with long-term therapy f) retinal changes & visual disturbances may progress after drug is stopped g) baseline & eye exams every 3-6 months h) discontinue for any visual disturbances 3) ethambutol (Myambutol, Etibi) a) color vision changes b) optic neuropathy - may be related to dose and duration of treatment - generally reversible when ethambutol is stopped - may continue to progress for 1-2 months after discontinuation - recovery may be delayed for > 1 year - irreversible blindness has been reported c) visual field defects d) eye exams at baseline & periodically thereafter - patients on > 15 mg/kg/day should have monthly eye exams e) notify provider of any vision changes 4) isotretinoin (Accutane), vitamin A1 a) cataracts b) conjunctivitis c) corneal opacities - dose-related & resolve in a couple of months after therapy is stopped d) decreased night vision may persist after therapy is stopped e) pseudotumor cerebri (intracranial hypertension) f) papilledema g) photophobia h) reduced tolerance to contact lenses i) visual changes are dose related j) stop retinoid if any visual difficulties or headaches, with eye exam to rule out papilledema secondary to intracranial hypertension k) periodic eye exams if oral retinoid therapy for >= 6 months 5) linezolid (Zyvox, Zyvoxam) a) optic neuropathy - decreased vision & color vision, visual field defects b) reported cases occurred after 5-11 months of therapy c) symptoms improve after discontinuation d) eye exam if treatment for >= 3 months 6) vigabatrin (Sabril)-Canada only a) optic atrophy b) optic neuritis c) peripheral constriction of visual field - occurs in ~ 30% of patients - usually occurs in the first 4 years of treatment d) mechanism may be retinal toxicity from elevated levels of GABA e) visual field defects are likely permanent even after stopping vigabatrin f) visual field examinations before or soon after starting vigabatrin are recommended, then every 3 months thereafter 7) voriconazole (Vfend) a) optic neuritis b) papilledema c) ocular adverse effects have occurred mainly in severely ill patients d) if administration > 28 days, visual function should be monitored

General

drugs with adverse ocular effects

References

Prescriber's Letter 16(1): 2009 Drug-Induced Ocular Effects Detail-Document#: 250124 (subscription needed) http://www.prescribersletter.com

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