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MattiSeppänen

Ocular Adverse Effects of Systemic Medication

Essentials

  • Systemic medication can have transient or permanent ocular adverse effects.
  • The drug causing impaired vision should be identified.
  • If a patient is taking systemic medication that may have ocular effects, they should be asked to have regular ophthalmological checkups.

Antiarrhythmic medication

Amiodarone

  • Symptoms: coloured rings or halos around lights
  • Possible ocular adverse effects
    • Non-arteritic anterior ischaemic optic neuropathy (NAION)
    • Corneal changes that may disappear after discontinuation of the drug
  • Ophthalmological checkups if there are symptoms

Antineoplastic agents

Tamoxifen

  • A combination of chemotherapy and one or more oestrogen receptor modulators may increase the risk of ocular adverse effects.
  • Possible ocular adverse effects
    • Reduced visual acuity (may be permanent)
      • Retinal changes
      • Oedema and haemorrhages in the area of the retina responsible for seeing fine detail (macula)
      • Changes in the retinal pigment epithelium
      • Cataract
    • Irritation of the eye area
  • Ophthalmological checkups
    • If there are symptoms
    • If the patient has been diagnosed with age-related macular degeneration Age-Related Macular Degeneration (AMD), checkup by an ophthalmologist when the medication is started

Combination product with tegafur-gimeracil-oteracil (Teysuno® )

  • Common ocular adverse effects: visual disturbances, lacrimal disturbances, conjunctivitis, corneal disturbances
  • Ophthalmological checkup if there are symptoms

Drugs for the treatment of erectile dysfunction

Sildenafil

  • Common ocular adverse effects (are associated with the use situation and are transient)
    • Impaired colour vision
    • Visual disturbances
    • Blurred vision
  • Uncommon ocular adverse effects
    • Disturbances of the lacrimal system, eye pain, photophobia, photopsia, ocular hyperaemia, increased brightness , conjunctivitis
  • Rare ocular adverse effects
    • NAION, retinal vascular occlusion, retinal haemorrhage, arteriosclerotic retinopathy, retinopathy, glaucoma, visual field defects, diplopia, impaired visual acuity, myopia, asthenopia, eye floaters, iris disorders, mydriasis, halo effects, ocular oedema, ocular swelling, ocular disturbances, conjunctival hyperaemia, ocular irritation, abnormal sensation in the eye, swelling of the eyelids, discoloration of the sclera
  • Ophthalmological checkups if there are symptoms

Tadalafil

  • Rather rare adverse effects
    • Blurred vision, eye pain
  • Rare adverse effects
    • Visual field defect, eyelid swelling, conjunctival injection, NAION, retinal vascular occlusion

Vardenafil

  • Rather rare adverse effects
    • Visual disturbances, ocular injection, colour vision distortions, eye pain and discomfort, photophobia
  • Rare adverse effects
    • Increased intraocular pressure, increased tear formation, NAION, visual disturbances

Drugs for the treatment of prostatic hyperplasia

Tamsulosin, alfutsosin, silodosin

  • The possibility of intraoperative floppy iris syndrome (IFIS) should be considered when planning cataract surgery. When referring patients for cataract surgery, check whether they have ever taken these medications. The effect is permanent and occurs even after a long time after the patient has stopped taking the medicine.
  • There is no particular need for ophthalmological checkups.

Antiepileptic drugs

Vigabatrin

  • Ocular adverse effects
    • Visual field defects (nasal, bilateral)
    • Blurred vision
  • Findings
    • Thinning of ocular nerve fibre layers
    • Pallor of the optic nerve head
  • Ophthalmological checkup if there are symptoms

Lamotrigine

  • Possible ocular adverse effects: double vision, blurred vision, conjunctivitis
  • Ophthalmological checkup if there are symptoms

Phenytoin

  • Blurred vision is a common ocular adverse effect
  • Double vision is rather uncommon
  • Ophthalmological checkup if there are symptoms

Acne medication

Isotretinoin

  • Common ocular adverse effects: blepharitis, conjunctivitis, dry eye, eye irritation
  • Refer promptly for an ophthalmological checkup if there are severe dry eye symptoms.

Antirheumatic medication

Hydroxychloroquine and chloroquine

  • Possible ocular adverse effects
    • Corneal deposits
    • Retinal changes
  • Ophthalmological checkups
    • When starting medication and after about 5 years of use
    • If necessary, regularly as advised by an ophthalmologist

    References

    • Seppänen M, Kaarniranta K, Setälä N, Uusitalo H (eds.). [Handbook of Ophthalmology]. 3rd revised edition. Duodecim Publishing Company 2022. Available in Finnish.

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