6.1.15 Recognises adverse ocular reactions to meds Flashcards
Describe amiodarone and side effect on eye?
used in the treatment of hypertension. Most patients develop corneal
microdeposit in a whorl like pattern within the corneal epithelium (Vortex Keratopathy).
* These deposits rarely interfere with vision but may increase glare and haloes.
* If vision is impaired or optic neuritis or neuropathy (AION) is present refer
immediately due to possibility of a phototoxic reaction.
* These deposits are reversible with the withdrawal of treatment (3 to 7 months).
* Px can also develop small anterior sub-capsular yellow/white lenticular opacities
within the pupil zone.
Describe vigabatrin and side effect on eye?
a drug used to treat epilepsy only given to Px which other combinations are
inadequate or not tolerated.
* 1/3 of Px suffer a visual field defect with onset from 1 month to several years.
o The defect is an asymptomatic predominantly nasal concentric peripheral
field loss sparing the macula and temporal area.
o Defect persists after withdrawal of medication.
* Colour vision, contrast sensitivity and VA can be affected.
Describe corticosteroids and effect on eye?
Corticosteroids affect the crystalline lens when used over prolonged
periods. Steroid cause the formation of posterior sub-capsular cataracts.
* typically bilateral and irreversible.
* Px tend to report photophobia, reading problems and difficulty with glare
Steroids have the potential in susceptible individual to raise IOP and cause glaucomatous
damage.
* Optic disc oedema is a rare OAR.
Describe hydroxychloroquine and effect on eye?
Is used to rheumatoid arthritis due to the greater risk of toxicity
chloroquine is only used to treat chronic inflammation as a last resort.
* Hydroxychloroquine is safer and rarely associated with toxicity.
* Patients at risk of toxicity are those on treatment for five years or longer.
* Corneal deposits (vortex keratopathy) can occur as early as 3 weeks.
* Chloroquine can induce in 1-2% of Px retinal and macular changes.
Pre-maculopathy: consists of early functional and structural changes prior to visible
fundus signs Early maculopathy: VA 6/9-6/12 and subtle macular disturbance.
Progression of maculopathy:
* moderate to severe reduction in VA (6/36-6/60)
* Bulls-eye macular lesion – island of pigment surrounded by depigmented area of
RPE atrophy
Describe tamoxifen and effect on eye?
used to treat breast cancer or prophylactically in Px with strong FH.
Tamoxifen is associated with
* bilateral superficial maculopathy (yellow/white crystal-like opacities surrounding
macula).
* It affects VA with associated Cystoid Macula Oedema.
o Reversible if detected early enough.
* Mild to moderate tritanomalous CV defect
* central scotomas within the Amsler chart area.
* Corneal deposits (vortex keratopathy).
Describe sertraline/amitriptyline and effect on eye?
are anti-depressants used to treat depression. These drugs
are associated mydriasis and thus blurred vision in particular difficulties with near vision.
What is BNF for?
For any medication, you are unsure about the BNF in all clinical relevant
systemic and ocular side effects for all drugs
How do you report a side effect of drug?
Reports can be submitted using the yellow cards at the rear of the
BNF or by downloading the Yellow Card from the MHRA website or submitting a
report online.
A yellow card report should be completed independently or if preferred in
consultation with patient medical prescriber when its suspected than an OAR may be
related to a drug or combination of drugs.
Inform Px GP of course of action. Practitioners should be deterred even if it seems to
be an isolated-case or some details requested by the yellow card are not known.
Give examples of anticoagulants and what ocular side effect do they cause?
Aspirin, warfarin
Increase risk of sub-conjunctival haemorrhage.
