Eye Disorders

Question 1

MF is a 78-year old smoker who is newly diagnosed with the dry form of age-related macular degeneration (AMD). When counselling this patient, you recommend that:
a) She continue smoking
b) She take a vitamin compound containing beta-carotene and vitamins C and E
c) She take a vitamin compound containing copper, zinc, vitamins C and E
d) She always wear sunglasses

Answer 1

C. Smoking is implicated in up to 30% of vision loss from AMD. Beta-carotene containing formulations are no longer recommended for the prevention to AMD (page 333, CTC, 7th edn). It is not known if wearing sunglasses has an impact on the condition. Self-monitoring with an Amsler grid will help detect the progression to the wet form of AMD in the 5% of patients in which this occurs.

Question 2

Red Flags by condition and drug induced conditions: Glaucoma

DRUG INDUCED Glaucoma

Answer 2

Corticosteroids
Drugs with antimuscarinic activity eg antihistamines, decongestants, antidepressants, antispasmodics
Anticonvusant topiramate associated with acute – closure glaucoma

Question 3

Red Flags by condition and drug induced conditions: Phototoxic reactions

Phototoxic Rxns

Answer 3

Antimicrobials: antimalarials, (chloroquine, quinine), azone antifungals (itraconazole, vorixoazole), ceftazidime, pyrazinamide, quinolones (ciprofloxacin, norfloxaxin, ofloxacin), sulfonamides, tetracyclines (doxyclycline, tetracycline), trimethoprim

Antineoplastics: dacabazine, EGF inhibitors (cetuximab, erlotinib, gefitinib, lapatinib, panitumumab), 5-fluorouracil, paclitaxel, vermurafenib, vinblastine

Diuretics: furosemide, hydrochlorothiazide

HMG-CoA Reductase Inhibitors

NSAIDS: diclofenac, ibuprofen, indomethacin, ketoprofen, naproxen, piroxicam, sulindac, tiaprofenic acid

Psychiatric medications: alprazolam, chlordiazepoxide, chlorpromazine, desipramine, fluphenazine, imipramine, perphenazine, prochlorperazine, trifluoperazine

Retinoids, systemic: (acitretin, alitretinoin, isotretinion

Retinoids topical: adapalene, tazarotene, tretinoin

Others: amidarone, coal tar derivatives, diltiazem, eculizuman, fluorescein, methoxasalen, rose bengal, quinidine, sulfites, tolbutamide, verteporfin

Question 4

Red Flags by condition and drug induced conditions: Phototoxic reactions