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Ocular toxicology
1PharmaLogic Development, Inc., Irvine, California, USA.
Abstract:
In this review of recent articles on ocular toxicology, the author concentrates on undesirable effects on the eye induced by systemically used xenobiotics. These effects include increased tear flow elicited by systemic cyclosporine; uveitis associated with inactivated influenza vaccine, intravenous immunoglobulins, or skin tattoos; iritis associated with intravenous streptokinase; corneal epithelial erosion associated with the use of an alcohol-based antimisting spray; decreased color vision associated with workplace exposure to perchloroethylene, or to digoxin; myocardial ischemia induced by topical atropine; and systemic exposure to cyclopentolate after topical instillation. Ocular irritation associated with systemic use of 5-fluorouracil may be attenuated with prophylactic ice packs. At doses evaluated for treatment of choroidal neovascularization, systemic alpha interferon leads to toxicity in multiple organ systems. Promethazine precipitates when injected into intravenous lines with fluorescein. No drug achieves ultimate efficacy or ultimate safety. Thus, the decision to employ a given therapy involves a physician's evaluation of its therapeutic index-the ratio between efficacy and toxicity.
Insights
Systemic medications and xenobiotics can cause various ocular toxicities, affecting vision and eye health. Physicians must carefully weigh the therapeutic index (efficacy vs. toxicity) before prescribing treatments.
Area of Science:
- Ophthalmology
- Toxicology
- Pharmacology
Background:
- Systemic xenobiotics can induce a range of adverse ocular effects.
- Understanding these toxicities is crucial for patient safety and effective treatment.
Purpose of the Study:
- To review recent literature on ocular toxicities caused by systemically administered xenobiotics.
- To highlight specific examples of drug-induced eye conditions and their management.
Main Methods:
- Literature review of recent articles on ocular toxicology.
- Focus on undesirable ocular effects from systemically used xenobiotics.
Main Results:
- Systemic cyclosporine can increase tear flow.
- Various agents (influenza vaccine, immunoglobulins, tattoos, streptokinase) are linked to uveitis or iritis.
- Corneal erosion, decreased color vision, and myocardial ischemia are reported with specific exposures.
- Systemic alpha interferon shows multi-organ toxicity; promethazine can precipitate with fluorescein.
Conclusions:
- No medication offers absolute efficacy or safety.
- Physicians must evaluate the therapeutic index (efficacy-to-toxicity ratio) for each patient.
- Careful risk-benefit assessment is essential when using systemic therapies with potential ocular side effects.