[The eye as target of adverse ocular drug reactions. Focus on systemic antiinfective therapy]

The functions of the eye can be disturbed by pharmaceutical agents via various mechanisms. This review describes the complexity of ocular adverse drug reactions and underlines the need for a close interdisciplinary cooperation especially in this field to optimize drug safety. Antimicrobial agents will be used as examples to describe ocular adverse drug reactions. A recent case control study describes fluoroquinolones to be associated with the occurrence of retinal detachments. The high affinity of these agents to melanin may cause intraocular accumulation. Fluoroquinolones exert toxic effects on collagens which may destabilize the structure of the extracellular matrix. The ketolid telithromycin may cause impaired accommodation and binocular vision potentially due to its anticholinergic effect. Linezolid, an oxazolidinone, used against infections with methicillin resistant staphylococcus aureus (MRSA) may lead to progressive, potentially irreversible neuropathies of the optic nerve especially in long-time application. Treatment with rifabutin or the antiviral drug cidofovir may cause intraocular inflammation. In addition, cidofovir may impair the production of the aqueous fluid due to a toxic effect on ciliary epithelial cells. During therapy with voriconazol about one third of patients suffer from reversible visual disturbances. Liver dysfunction or pharmacogenetic variants in the cytochrome P450 system may contribute to a retarded metabolism with high intraocular drug levels. In summary, this review indicates the complexity of ocular adverse drug reactions and points out that an interdisciplinary approach is necessary to improve pharmacovigilance in this field.