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Ocular adverse effects associated with systemic medications : recognition and management

Ricardo M Santaella1, Frederick W Fraunfelder

  • 1Casey Eye Institute, Oregon Health & Science University, Portland, OR 97201, USA.

Drugs
|January 11, 2007
PubMed

Insights

Systemic medications can cause various ocular adverse effects, including glaucoma, visual field defects, and vision changes. Healthcare professionals must detect and manage these drug-induced eye problems.

Area of Science:

  • Ophthalmology
  • Pharmacology
  • Toxicology

Background:

  • Systemic medications are frequently associated with ocular adverse effects.
  • Understanding these drug-induced ocular toxicities is crucial for patient safety.
  • Existing literature highlights numerous medications with potential ocular side effects.

Purpose of the Study:

  • To review common ocular adverse effects linked to systemic therapies.
  • To evaluate the certainty of adverse effect profiles using the WHO Causality Assessment Guide.
  • To inform healthcare professionals about drug-related eye conditions.

Main Methods:

  • Review of retrospective case series and reported adverse events.
  • Evaluation of medication certainty using the WHO Causality Assessment Guide.
  • Identification of specific drugs and their associated ocular toxicities.

Main Results:

  • Certainty established for bisphosphonates (pamidronate, alendronate) causing scleritis, uveitis, and blurred vision.
  • Topiramate linked to acute angle-closure glaucoma; vigabatrin to irreversible visual field defects.
  • Isotretinoin associated with pseudotumor cerebri; amiodarone with optic neuropathy; hydroxychloroquine with maculopathy.
  • Sildenafil may cause visual perception changes and anterior ischemic optic neuropathy.
  • Tamoxifen linked to dose-dependent maculopathy; COX-2 inhibitors to reversible conjunctivitis.
  • Herbal medications like Ginkgo biloba and Echinacea also associated with ocular effects.

Conclusions:

  • Numerous systemic drugs, including bisphosphonates, topiramate, vigabatrin, isotretinoin, amiodarone, hydroxychloroquine, sildenafil, tamoxifen, COX-2 inhibitors, and herbal remedies, can cause significant ocular adverse effects.
  • Healthcare professionals play a vital role in detecting, treating, and educating patients about these medication-induced eye conditions.
  • Regular monitoring and screening are essential for patients on specific systemic therapies known to cause ocular toxicity.

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