Drugs effect to the eye

7/29/2019 Drugs effect to the eye

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Eyelid and Conjunctival Diseases

The eyelids and conjunctiva (a thin membrane covering the inner part of the eyelid

and the outer part of the cornea, but not shown in the eye diagram) are frequent

targets for drug toxicity.

For instance, a panoply of drugs can cause erythema multiforme, a kind of allergic

reaction of the skin (including the eyelid) that produces a variety of skin lesions

ranging from bumps to plaques to blisters. In its most severe form, it is called

Stevens-Johnson Syndrome, a serious condition of the conjunctiva characterized

primarily by large blisters that can seriously damage the cornea. The primary

treatment in both cases is to stop using the drug that is causing the allergic

reaction, after consultation with one’s physician.

Drugs instilled into the eye that contain the preservatives benzalkonium chloride

and thimerosol can cause redness of the conjunctiva. If you experience this, look

for versions of your drug without these preservatives. Morphine administered by

mouth or intravenously can also cause red eye. Finally, the spread of botulinum

toxin (BOTOX) from the point of injection into the eyelid can result in eyelid

drooping and reduced blinking, potentially resulting in damage to the cornea.

Uveal Tract Diseases

Together, the iris, the ciliary body (not shown in the eye diagram) and the choroid

are known as the uvea. A number of alpha-1 blockers, especially tamsulosin



(FLOMAX), have been implicated in a condition known as floppy iris syndrome in

which the iris is more mobile, potentially complicating surgery. It has no impact

upon vision or eye health and thus causes no apparent symptoms, but eye

surgeons should be told if you have ever taken these drugs.

Glaucoma

Glaucoma is a disease with characteristic damage to the optic nerve; raised

pressure in the eye is an important risk factor. The disease can be divided in two:

cases in which the pressure in the eye is raised without being caused by any

particular anatomical abnormality (open-angle glaucoma) and cases in which wide

opening (dilation) of the pupil or swelling of certain eye structures (e.g., ciliary

body and lens) results in a narrowing of the angle between the cornea and the iris,

preventing the flow of fluid (vitreous humor) within the eye. This, in turn, can lead

to pressure build-up (angleclosure glaucoma). Drugs have been known to cause

both forms of glaucoma and both can lead to blindness.

In open-angle glaucoma, pressure in the eye builds up slowly, reducing the visual

field, but causing no pain or redness. The most commonly implicated drugs are

corticosteroids — e.g., cortisone (CORTONE) or prednisone (DELTASONE) —

whether administered into the eye, by mouth or by any other route. Certain

anticancer drugs have also been shown to cause this condition.

Angle-closure glaucoma is characterized by the sudden onset of severe eye pain,

redness and cloudy vision. Drugs in the adrenergic and anticholinergic categories

(see table for examples) can cause dilation of the pupil, while topiramate (TOPA-

MAX) and other sulfa drugs can cause swelling of the ciliary body; both can reduce

the cornea-iris angle, producing glaucoma.

Cataracts

The eye lens is a malleable structure that focuses light rays on the retina. A

cataract is a condition in which the lens becomes cloudy, frequently leading to

surgical removal as vision is increasingly impaired. Corticosteroids have long been

associated with cataracts, regardless of how they are administered, but the direct

injection into the eye of one particular steroid, triamcinolone, often to treat

macular edema, almost always leads to a cataract. Steroid-induced cataracts do

not usually regress when the drug is stopped. Other classes of drugs associated

with cataracts are the phenothiazine antipsychotics and the anti-cancer drug



busulfan.

Retinal Abnormalities

The retina acts like the film in a camera, sensing the play of light on its surface

and transforming the light waves into electrical signals that travel down the optic

nerve and then to the optical cortex in the brain which allows you to see the

images. Toxic substances can reach the retina through the blood supply,

potentially resulting in significant visual disturbances.

Chloroquine and hydroxychloroquine are drugs used in the treatment of malaria,

amoebae, rheumatoid arthritis and lupus. Retinal damage is reversible only in the

earliest stages of the disease, so it is crucial to have various eye examinations

when one starts these drugs and every six to 12 months thereafter. The

antipsychotic drugs chlorpromazine and thioridazine have already been mentioned

as causes of cataracts. Both of them, especially thioridazine, can lead to blurred

vision, loss of visual fields and loss of night vision as pigment is deposited in the

retina. The breast cancer treatment tamoxifen (NOLVADEX) can also cause retinal

changes and decreased color vision as crystals deposit in the retina; examinations

when the drug is started and at least every two years are necessary as long as one

is on the drug. Isotretinoin (ACCU- TANE) and other drugs in its class can cause

blurred vision and decreased night vision.

Optic Nerve Diseases

The optic nerve carries visual information from the retina to the brain. A number of

drugs can affect the nerve, but stopping them when symptoms occur usually

improves or resolves the problem.

Prolonged use of the antibiotic linezolid (ZYVOX) can produce optic nerve damage

characterized by visual field defects, decreases in color vision and in vision more

generally. Erectile dysfunction drugs are known to cause bluish vision, blurred

vision and increased sensitivity to light. In addition, they have also been

associated with a condition called nonarteritic ischemic optic neuropathy (NAION).

Public Citizen has filed a petition asking the Food and Drug Administration to issue

a black box warning about this complication (see Worst Pills, Best Pills News,

January 2006). The disease takes the form of sudden onset of visual loss that may

lead to complete blindness; if the drug is stopped, the symptoms may reverse over

a few weeks. In contrast, amiodarone (CORDERONE, PACERONE)- induced optic

nerve damage has a slower onset, is less likely to lead to complete blindness and



reverses more slowly. The anti-tuberculosis drug ethambutol (MYAMBUTOL) also

causes optic nerve damage and various vision abnormalities such as loss of color

vision and visual acuity.

What You Can Do

As is true for other parts of the body, you should consider newly developed eye

symptoms beginning shortly after starting a new medication to be possibly drug-

induced and consult a physician.

Table: Commonly used drugs associated with eye diseases

Disease Generic Name Brand Name

Eyelid and Conjunctival Diseases

Erythemamultiforme

acetaminophen TYLENOL

allopurinol ZYLOPRIM

amiodarone CORDARONE, PACERONE

ampicillin OMNIPEN

captopril CAPOTEN

cefazolin

clindamycin CLEOCIN

doxycycline VIBRAMYCIN

isoniazid INH

penicillin

phenobarbital LUMINAL, SOLFOTON

sulfamethoxazole (withtrimethoprim)

BACTRIM, COTRIM, SEPTRA

sulfisoxazole GANTRISIN

vancomycin VANCOCIN

Stevens-

JohnsonSyndrome

Same as erythema

multiforme

Red eye Drugs containingbenzalkonium chloride

Certain drugs used in the eye

Drugs containingthimerosol

Certain drugs used in the eye

morphine

Eyelid droop botulinum toxin BOTOX

Uveal Tract Diseases

Eye surgery alfuzosin UROXATRAL



complications doxazosin CARDURA

prazosin MINIPRESS

sildenafil VIAGRA

tadalafil CIALIS

tamsulosin FLOMAX

terazosin HYTRIN

vardenafil LEVITRA

Glaucoma

Open-angleglaucoma

betamethasone ALPHATREX, DIPROLENE,DIPROSONE

desoximetasone TOPICORT

dexamethasone DECADRON, HEXADROL,

MYMETHASONE

docetaxel TAXOTERE

fluocinolone SYNALAR

fluocinonide LIDEX-E, LIDEX

hydrocortisone (oral) CORTEF, HYDROCORTONE

hydrocortisone (topical) ALA-CORT, HI-COR, HYTONE,

NEACLEAR LIQUID OXYGENSCAR, PENECORT, SYNACORT

methylprednisolone MEDROL

paclitaxel TAXOL

prednisolone PRELONE

prednisone DELTASONE

triamcinolone (topical) ARISTOCORT, KENALOG,

TRIACET, TRIDERM

Angle-closureglaucoma

cimetidine TAGAMET

ephedrine

epinephrine ADRENALINE, PRIMATENE MIST

fluoxetine PROZAC, SERAFEM

fluvoxamine LUVOX

ipratropium ATROVENT

paroxetine PAXIL, PEXEVA

ranitidine ZANTAC

sulfamethoxazole (withtrimethoprim)

BACTRIM, COTRIM, SEPTRA

sulfisoxazole GANTRISIN

topiramate TOPAMAX

venlafaxine EFFEXOR, EFFEXOR XR



Cataracts

betamethasone ALPHATREX, DIPROLENE,DIPROSONE

busulfan BUSULFEX, MYLERAN

chlorpromazine THORAZINE

desoximetasone TOPICORT

dexamethasone DECADRON, HEXADROL,

MYMETHASONE

fluocinolone SYNALAR

fluocinonide LIDEX-E, LIDEX

hydrocortisone (oral) CORTEF, HYDROCORTONE

hydrocortisone (topical) ALA-CORT, HI-COR, HYTONE,NEACLEAR LIQUID OXYGENSCAR, PENECORT, SYNACORT

methylprednisolone MEDROL

prednisolone PRELONE

prednisone DELTASONE

thioridazine MELLARIL

triamcinolone(injectable)

triamcinolone (topical) ARISTOCORT, KENALOG,

TRIACET, TRIDERM

Retinal Abnormalities

acitretin SORITANE

chloroquine ARALEN

chlorpromazine THORAZINE

etretinate TEGISON

hydroxychloroquine PLAQUENIL

isotretinoin ACCUTANE

tamoxifen NOLVADEX

thioridazine MELLARIL

tretinoin RENOVA, RETIN-A

vitamin A (retinol) AQUASOL A

Optic Nerve Diseases

amiodarone CORDARONE, PACERONE

ethambutol

linezolid ZYVOX

sildenafil VIAGRA

tadalafil CIALIS



vardenafil LEVITRA

Drugs effect to the eye

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