Medication Induced Ophthalmic Issues
Introduction
Medications can cause ocular adverse effects.
- Most disappear once the drug is discontinued (such as blurry vision from an anticholinergic).
- In other cases, the damage can be permanent (such as vision loss with a PDE-5 inhibitor).
Common Drugs Known to Cause Vision Changes or Damage
Eye inflammation
Bisphosphonates (e.g. alendronate) - conjunctivitis, episcleritis, scleritis, keratitis or uveitis
Retinal changes/retinopathy
Chloroquine
Hydroxychloroquine
Optic neuropathy
Amiodarone (plus corneal deposits)
Ethambutol
Linezolid
Intraoperative floppy iris syndrome (IFIS); causes difficulty in cataract surgery
Alpha-blockers (e.g. tamsulosin)
Colour discrimination
Digoxin (with toxicity) - yellow/green vision
PDE-5 inhibitors (e.g. sildenafil) - greenish tinge around objects
Voriconazole - Colour vision changes
Vision loss/abnormal vision
Clomiphene - blurred vision, reduced visual acuity, phosphenes (flash in the visual field), scintillating scotomas (spots in the visual field), blindness
Digoxin (with toxicity) - blurriness, halos
PDE-5 inhibitors - vision loss (one or both eyes; can be permanent)
Gabapentin - nystagmus, diplopia and visual field defects
Isotretinoin - reduced night vision (can be permanent), dryness, irritation
Topiramate - visual field defects
Vigabatrin - permanent vision loss (high risk)
Voriconazole - abnormal vision, photophobia
Cataract formation
Allopurinol - long-term use
Corticosteroids - also raises intraocular pressure
Summary
Patients must be instructed to report visual changes immediately; in most cases, the damage is reversible if the medication is stopped quickly.
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