REVIEW - 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.

Santaella RM, Fraunfelder FW.

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

97201, 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/pubmed/17209665

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Not an MD