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Urologic medications and ophthalmologic side effects: a review
Johan Gani1, Nathan Perlis, Sidney B Radomski
1Division of Urology, Toronto Western Hospital, University Health Network, Toronto, ON.
Summary
Urologic medications like alpha-blockers can affect eye surgery. Patients on alpha-blockers should stop them before cataract surgery unless urinary retention risk is high, requiring ophthalmologist consultation.
Area of Science:
- Ophthalmology
- Urology
- Pharmacology
Background:
- Commonly prescribed urologic medications can cause significant, yet conflicting, ophthalmologic side effects.
- Existing literature lacks clear guidance on managing urologic medications during ophthalmic procedures.
Purpose of the Study:
- To review the ophthalmologic side effects of common urologic medications.
- To provide recommendations for managing alpha-blockers, PDE5 inhibitors, and anticholinergic medications in patients undergoing ophthalmic surgery.
Main Methods:
- Literature review and synthesis of evidence regarding urologic medications and ocular side effects.
- Analysis of specific drug classes: alpha-blockers, phosphodiesterase type 5 (PDE5) inhibitors, and anticholinergic medications.
Main Results:
- Alpha-blockers are associated with intraoperative floppy iris syndrome (IFIS); preoperative discontinuation is recommended for cataract surgery unless urinary retention risk is high.
- Phosphodiesterase type 5 (PDE5) inhibitors lack convincing evidence for causing non-arteritic ischemic optic neuropathy (NAION), but patients should be informed of potential visual loss risks.
- Anticholinergic medications rarely cause acute angle closure glaucoma (AACG) in narrow-angle eyes but are safe for open-angle glaucoma patients.
Conclusions:
- Patients undergoing cataract surgery should stop alpha-blockers preoperatively, with exceptions for high urinary retention risk.
- Advise patients on potential visual risks with PDE5 inhibitors, especially those with cardiovascular disease.
- Urologists must consult ophthalmologists regarding glaucoma history before prescribing anticholinergic medications.
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