RESEARCH - Ocular adverse effects associated with systemic medications: recognition and management

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Drugs. 2007;67(1):75-93

Ocular adverse effects associated with systemic medications : recognition

and management.

Casey Eye Institute, Oregon Health & Science University, Portland, Oregon,

USA.

This article reviews several retrospective case series and reported adverse

events regarding common ocular adverse effects related to systemic therapy.

It is not intended as a comprehensive summary of these well described

adverse drug reactions, nor is it intended to cover the complete spectrum of

all ocular adverse effects of systemic therapy. Many systemic drugs may

produce ocular toxicity, including bisphosphonates, topiramate, vigabatrin,

isotretinoin and other retinoids, amiodarone, ethambutol, chloroquine and

hydroxychloroquine, tamoxifen, quetiapine, cyclo-oxygenase (COX)-2

inhibitors, erectile dysfunction agents and some herbal medications. For

this review, the certainty of the adverse effect profile of each medication

was evaluated according to the WHO Causality Assessment Guide.A certain

relationship has been established for pamidronate and alendronate as causes

of scleritis, uveitis, conjunctivitis and blurred vision. Topiramate has

been established as adversely causing symptoms consistent with acute

angle-closure glaucoma, typically bilateral. Vigabatrin has been shown to

cause bilateral irreversible visual field defects attributed to underlying

medication-induced retinal pathology. Isotretinoin should be considered in

the differential diagnosis of any patient with pseudotumour cerebri.

Patients taking amiodarone and hydroxychloroquine should be monitored and

screened regularly for development of optic neuropathy and maculopathy,

respectively. Sildenafil has been reported to cause several changes in

visual perception and is a possible, not yet certain, cause of anterior

ischaemic optic neuropathy. Patients taking tamoxifen should also be

monitored for development of dose-dependent maculopathy and decreased colour

vision. COX-2 inhibitors should be included in the differential diagnosis of

reversible conjunctivitis. Several herbal medications including

canthaxanthine, chamomile, datura, Echinacea purpurea, Ginkgo biloba and

liquorice have also been associated with several ocular adverse effects.It

is the role of all healthcare professionals to detect, treat and educate the

public about adverse reactions to medications as they are an important

health problem.

PMID: 17209665

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=Abstra\

ctPlus & list_uids=17209665

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