Ocular Adverse Effects of Systemic Medications

Question 1

Hydroxychloroquine side effects and recommendations

Answer 1

• retinal toxicity
• baseline exam at drug initiation
• annual screening beginning at 5 years of drug use for low risk patients
• exam should include: DFE, 10-2 visual field (24-2 or 30-2 in Asian patients) and ONE of the following: multifocal ERG, SD-OCT, fundus autofluorescence

Question 2

Topiramate (Topamax) side effects and recommendations

Answer 2

• ciliary body effusion which relaxes zonules and allows for lens thickening –> myopic shift
• anterior rotation of CB and resultant angle closure
• no recommendations for baseline or monitoring

Question 3

Vigabatrin (Sabril) side effects and recommendations

Answer 3

• risk of progressive and permanent bilateral concentric VF loss and potential for reduced VA
• baseline and every 3 months exam (including VF)
• usually children see an OMD

Question 4

Fingolimod (Gilenya) side effects and recommendations

Answer 4

• possibility of macular edema

- recommend baseline exam (DFE and OCT) and at 3-4 months after first dose; home Amsler grid

Question 5

Isotretinoin (Accutane) side effects and recommendations

Answer 5

• meibomian gland dysfunction and atrophy, increased hordeolum/chalazion frequency
• no recommendations for screening

Question 6

Tamoxifen side effects and recommendations

Answer 6

• superficial whorl-like keratopathy (minor)
• crystalline retinopathy in plexiform and nerve fiber layers, can have macular edema
• recommendation: baseline and yearly dilated exam with mac OCT

Question 7

Ethambutol side effects and recommendation

Answer 7

• optic neuropathy with bilateral central vision loss, color vision loss, central scotomas, eventual optic atrophy
• recommend baseline exam with vision, color vision, Amsler, VF, and dilated exam with RNFL OCT and monthly evaluation

Question 8

Tamsulosin (Flomax) side effects and recommendations

Answer 8

• intraoperative floppy iris syndrome during cataract surgery
• notify the cataract surgeon prior to surgery if patient has ever been on drug

Question 9

Amiodarone side effects and recommendations

Answer 9

• corneal verticillata resolves after DC
• colored haloes around lights
• optic neuropathy (rare)
• recommend baseline, 6 month, and then yearly dilated exams

Question 10

Digoxin side effects and recommendations

Answer 10

• yellowing of vision (xanthopsia)
• flashing of lights, moving lights, misty or “snowy” vision
• no recommendations

Question 11

Anticoagulants side effects and recommendations

Answer 11

• increased bleeding (SCH, retinal hemorrhage, orbital hemorrhage)
• no recommendations

Question 12

Bisphosphonates side effects and recommendations

Answer 12

• really dramatic inflammation that may warrant dc of drug

- no recommendations

Question 13

immune checkpoint inhibitors side effects and recommendations

Answer 13

• inflammation (uveitis)

- no recommendations