Ocular Side Effects of Systemic Drugs Flashcards
whorl keratopathy
F CHAI T + R
chloroquine, hydroxychloroquine, amiodarone, tamoxifen, indomethacin
Fabry’s disease, Rho kinase inhibitors
dry eye disease
all drugs preserved with BAK, including topical ophthalmic glaucoma medications
superficial punctate keratitis (SPK)
isotretinoin (Accutane), topical ophthalmic aminoglycosides (Tobradex)
endothelial/Descemet membrane pigmentation, also on lens and retina
“-azine” drugs
chlorpromazine, thioridazine, promethazine (Phenergan)
stromal gold deposits
gold salts can result in yellow-brown deposits between the stroma and Descemets (ocular chrysiasis)
delayed corneal healing
topical ophthalmic and oral corticosteroids
Amiodarone
an anti-arrhythmic drug that can cause whorl keratopathy (epithelium), anterior subcapsular lens deposits, and NAAION (1-2% of cases)
anterior subcapsular effects/cataracts
“May trigger ant. cataract” = miotics (vacuoles), thioridazine, amiodarone (deposits), chlorpromazine
posterior subcapsular cataracts
corticosteroids
Isotretinoin (Accutane)
blepharoconjunctivitis, dryness, lid edema, loss of colour vision, nyctalopia, intracranial hypertension
subconjunctival hemorrhage
NSAIDs, warfarin (Coumadin), clopidogrel (Plavix), dipyridamole (Persantine), Sildenafil (Viagra)
sulfonamides
Stevens-Johnson syndrome and lid edema
tetracyclines
pigmented cysts on the conjunctiva, pseudotumor cerebri, papilledema
conjunctival hyperemia
Sildenafil, prostaglandin analogues
Tamiflu
(antiviral for influenza) can cause conjunctivitis in 1% of pts
decrease tear secretion
anticholinergics, TCAs, antihistamines, phenothiazines, isotretinoin, beta-blockers, hormone therapies (HRT, contraceptives), ADHD meds (methylphenidate, dextroamphetamine), diuretics (HCTZ, furosemide, triamterene)
miosis
opiates (morphine, heroine, codeine), acetylcholinesterase inhibitors
mydriasis
anticholinergics, antihistamines, SSRIs, SNRIs, TCAs, phenothiazines, benzos, dopamine agonists
nystagmus
phenytoin (Dilantin), phenobarbital (Luminal), salicylates (NSAIDs), topiramate
diplopia
antidepressants, antianxiety agents, phenytoin (Dilantin), pseudoephedrine
smooth pursuit impairment
alcohol
oculogyric crisis
phenothiazines, cetirizine (Zyrtec)
intraoperative floppy iris syndrome
a1 blockers (tamsulosin, terazosin, prazosin)
blue sclera
corticosteroids, minocycline
topiramate (Topamax)
secondary angle closure, choroidal swelling moves the iris forward into apposition with the TM
Digoxin
retrobulbar optic neuritis, B/Y colour defects, entoptic phenomena
Ethambutol
optic neuritis (typically retrobulbar and bilateral)
NAION
Sildenafil, vardenafil, sumatriptan, amiodarone
“VIA” - viagra, imitrex (sumatriptan), amiodarone
optic neuritis
“DICE” digoxin, isoniazid, chloramphenicol, contraceptives, ethambutol
streptomycin, sulfonamides, methotrextrate
oral contraceptives
decreased tear secretion, optic neuritis, papilledema, pseudotumor cerebri, vasculopathy (RAOs and RVOs), retinal hemorrhage, intracranial hypertension
chloroquine
bull’s eye maculopathy
epinephrine
cystoid macular edema
tamoxifen
white or yellow crystalline deposits (commonly in the macula) with or without macular edema, dry eye, cataracts, keratopathy
thioridazine/chlorpromazine/promethazine
pigmentary retinopathy that can have an appearance similar to bulls eye maculopathy, cataracts, whorl keratopathy, RP
indomethacin
retinal hemorrhage, pigmentary changes (especially in the macula)
talc
retinopathy (white, shiny emboli within arterioles)
zidovudine (Retrovir)
“-vudine” drugs
macular edema
NSAIDs
subconjunctival hemes, retinal hemes
drugs causing intracranial hypertension
tetracyclines, isotretinoin, oral contraceptives, nalidixic acid
drugs that decrease IOP
systemic beta-blockers, cardiac glycosides (digoxin), alcohol, cannabinoids
drugs that increase IOP
anticholinergics (atropine, scopolamine), antihistamines, TCAs, antipsychotics (phenothiazines), short-acting b2 agonists (albuterol, levalbuterol, terbutaline), pseudoephedrine, corticosteroids
drugs that can cause pseudotumor cerebri/IIH
CATS: contraceptives, accutane, tetracyclines, synthroid (<18yo)
beta-blockers should be used cautiously in
diabetics as it can mask symptoms of fatal hypoglycemia
(can also mask symptoms of hyperthyroid)
myasthenia gravis
“-zone” diabetic drugs
macular edema
ribavirin (hep c therapy) +interferon
conjunctivitis, RD, ischemia (CWS), bleeding (retinal hemes), arterial/venous occlusions, and optic neuritis
acute secondary angle closure glaucoma
topiramate, HCTZ, chlorothiazide
myopic shift drugs
May Have To See Dimly
miotics, HCTZ, topiramate, sulfa, diamox (CAIs)
Stevens-Johnson syndrome
Sulfonamide, phenytoin, NSAIDs, penicillin, aspirin, barbiturates, isoniazid, tetracyclines, immunizing vaccinations
pseudoephedrine
blurry vision, diplopia
pigmentary retinopathy
chlorpromazine, thioridazine, indomethacin, promethazine
promethazine
pigment x3 - corneal endo, lens, retinal pigment
antihistamine (symp) effects - dry mouth, mydriasis, dry eyes, tachy cardia, etc.
EOM palsies
Phenytoin
