drugs with adverse ocular effects

Includes: 1) alpha-1 adrenergic receptor antagonists (alpha-blockers) a) blurred vision b) eye pain c) floppy-iris syndrome (most frequent with tamsulosin) 2) 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 s6-12 months g) patients should call provider if visual disturbances 3) bisphosphonates a) blurred vision b) conjunctivitis c) episcleritis d) eye pain e) iritis f) scleritis g) uveitis h) ocular adverse effects are associated with inflammation, possibly immunologic in nature i) may be seen within 48 hours after starting pamidronate j) may be seen two days to 2 weeks after starting alendronate k) stopping bisphosphonate may resolve ocular adverse effects 4) canthaxanthin a) altered eye function b) decreased visual acuity c) retinal deposits d) reaction is dose-related e) symptoms are reversible f) patients are frequently asymptomatic 5) celecoxib (Celebrex) a) blurred vision b) cataracts c) conjunctivitis d) conjunctival hemorrhage e) eye pain f) glaucoma g) vitreous floaters h) adverse effects might be caused by alteration of retinal blood flow &/or inflammation resulting from secretion of the medication in tears i) stopping celecoxib should resolve most ocular side effects within 72 hours 6) 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 7) corticosteroids a) cataracts b) glaucoma c) optic neuritis d) retinopathy e) risk associated with prolonged use of inhaled, oral, or topical corticosteroids f) taper ASAP if intraocular pressure increases 8) digoxin a) visual disturbances b) reduced visual acuity c) visual symptoms can occur with therapeutic levels of digoxin d) symptoms can resolve with correction of supratherapeutic levels or with discontinuation of digoxin 9) 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 10) isoniazid - optic neuropathy, usually reversible & less severe than with ethambutol 11) 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 12) 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 13) niacin (Niaspan) a) cystoid macular edema - usually resolves within 2 weeks after stopping niacin b) decreased vision c) dry eyes 14) phenothiazines a) cataracts - dose & drug dependent - most common with chlorpromazine & thioridazine b) retinopathy - may develop within weeks-months with high-dose thioridazine - blurred vision is usually the initial symptom 15) phosphodiesterase-5 inhibitors a) blurred vision b) cataracts c) changes in color perception d) conjunctivitis e) dry eyes f) eye hemorrhage g) eye pain h) mydriasis i) non-arteritic anterior ischemic optic neuropathy - may result in decreased vision or permanent vision loss - causality of PDE5 inhibitors has not been established j) photophobia k) ocular adverse effects are dose-dependent l) PDE5 inhibitors should not be used in patients with hereditary degenerative retinal disorders m) stop PDE5 inhibitor & call provider if vision loss 16) tamoxifen (Nolvadex) a) cataracts, slow blurring of vision b) corneal opacities c) decreased color vision perception d) retinal vein thrombosis e) retinopathy - commonly occurs after > 1 year of therapy when a total of > 100 gm has been administered - an acute, reversible retinopathy can also develop within weeks of starting therapy f) patients should have an eye exam at baseline & every 2 years g) call provider for any ocular adverse effects 17) telithromycin (Ketek) a) blurred vision b) difficulty focusing c) double vision d) visual adverse events in ~ 2% of patients e) most visual adverse events occur following the 1st or 2nd dose f) visual adverse events may last several hours & recur with subsequent doses in some patients g) symptoms may resolve or continue with continued administration h) women < 40 years are most likely to experience adverse visual events i) call provider for any vision problems 18) tiagabine (Gabitril) a) abnormal vision b) deteriorating color vision c) mechanism may be retinal toxicity from elevated levels of GABA 19) topiramate (Topamax) a) acute angle-closure glaucoma - blurred vision, eye pain, headache, nausea, vomiting - pressure may return to normal in hours to days when tiagabine is stopped b) acute myopia, may take weeks to resolve c) increased ocular pressure - may occur within one month of therapy, & within hours after doubling the dose d) mydriasis e) call provider for blurred vision, visual disturbances, or eye pain 20) 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 21) 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

Specific

drugs that require eye exam

General

drug-induced eye disease

References

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

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