Drugs

      This information was summarized for the MD Support web site from the most recent publication of the National Registry of Drug-Induced Ocular Side Effects. For the complete report, see www.eyedrugregistry.com, or contact Casey Eye Institute, 3375 SW Terwilliger Blvd, Portland OR 97201-4197. Fax: (503) 494-4286.

Topiramate - Topamax

Primary Use: Topiramate is a novel agent used in various types of epilepsy, migraine headaches, depression, neuropathic pain and bipolar disorders. It is used "off label" as a "magic" weight reduction medication.

Certain side effects:
Acute glaucoma (angle closure)
Anterior shallowing
Decreased vision
Ocular pain
Headaches
Ocular hyperemia
Mydriasis-variable or absent
Uveitis
Visual field defects
Myopia (up to 6-8 diopters)
Suprachoroidal effusions

Probable/likely side effects:
Blepharospasm
Oculogyric crisis

Possible side effects:
Retinal bleeds
Scleritis
Teratogenic - ocular malformations

Pledgets of 10% Phenylephrine (Neo-Synephrine)

Primary Use: Hemostasis during LASIK procedures, potentiate pupillary dilation, lyse posterior synechiae.

Certain side effects:
Hypertension

Probable/Likely side effects:
Myocardial Infarction
Subarachnoid Hemorrhage

Sildenafil (Viagra)

Primary Use: Management of erectile dysfunction.

Certain side effects:
Changes in color perception
Objects have colored tinges - usually blue or blue/green, may be pink or yellow
Diminished color vision (Farnsworth-Munsell 100 Hue Test)
Dark colors appear darker
Blurred vision
Central haze
Transitory decreased vision
Changes in light perception
Increased perception of brightness
Flashing lights - especially when blinking
ERG changes
Conjunctival hyperemia
Photophobia.

Possible side effects (could be secondary, not directly drug-related):
Mydriasis
Anterior ischemic optic neuropathy
Retinal vascular accidents

Isotretinoin (Accutane)

Primary Use: Treatment of cystic acne, psoriasis and various skin disorders.

Certain side effects:
Abnormal meibomian gland secretion
Meibomian gland atrophy
Blepharoconjunctivitis
Myopia
Corneal opacities
Ocular discomfort
Decreased dark adaptation
Ocular sicca
Decreased tolerance to contact lens
Photophobia.
Decreased vision
Increased tear osmolarity
Teratogenic ocular abnormalities
Keratitis
Teratogenic ocular abnormalities

Probable/likely side effetcs:
Decreased color vision (reversible)
Permanent loss of dark adaptation
Pseudotumor cerebri

Possible side effects:
Corneal ulcers
Optic neuritis
Diplopia
Permanent sicca-like syndrome
Eyelid edema
Subconjunctival hemorrhage
Idiopathic intracranial hypertension with optic disk edema

Unlikely side effects:
Activation of herpes simplex virus
Keratoconus
Corneal vascularization
Limbal infiltrates
Exophthalmos
Pupil abnormalities
Glaucoma
Vitreous disturbance

Conditional/Unclassifiable side effects:
Cataracts
Peripheral field loss
Cortical blindness
Retinal findings
Decreased accommodation
Scleritis
Iritis

Amiodarone (Cordarone)

Primary Use: Treatment of various cardiac arrhythmias.

Certain side effects:
Photosensitivity
Corneal microdeposits
Visual sensations:
    Hazy vision
    Colored halos around lights
    Bright lights
    Glare
Aggravate sicca (drug in tears)
Periocular skin pigmentation
Blepharoconjunctivitis
Thyroid eye disease

Probable side effects:
Corneal ulceration
Interior subcapsular lens opacities
Non-arteritic ischemic optic neuropathy
Loss of eyelashes or eyebrows
Pseudotumor cerebri

Possible side effects:
Autoimmune reaction (dry mouth, dry eyes, peripheral neuropathy, and pneumonitis)
Amiodarone-Induced Optic Neuropathy
Nonarteritic Anterior Ischemic Optic Neuropathy

Hydroxychloroquine/Chloroquine* (Plaquenil)

Primary Use: Treatment of rheumatoid arthritis and lupus erythematosis, dermatologic conditions, and various inflammatory disorders.

Side effects:
Scotomas
Retinal changes
Color vision loss
Decreased vision

*Chloroquine is no longer available except for malaria treatment, primarily military.

Carbonic Anhydrase Inhibitors (CAI)
Acetazolamide (Diamox), dichlorphenamide (Daranide), methazolamide (Glauctabs? & Neptazane)

Primary Use: Oral sales of CAI. Short-term use in cataract surgery, prevention of air hunger in mountain climbers, use in selected cases of macular edema, and as an ocular pressure-lowering drug.

Side effects:
CAI may significantly increase respiratory distress in chronic lu ng disease patients.
Causes osteomalacia in patients on anti-convulsive medication.
Patients on high doses of aspirin plus CAI can experience aspirin-induced CNS toxicity.
Can cause metabolic acidosis and coma, especially in patients with renal insufficiency or diabetics with nephropathy.
Patients with cirrhosis can get ammonia poisoning.
Stevens-Johnson syndrome - Japanese appear to be more susceptible.
Concomitant use of CAI may increase five-fold trough blood levels of cyclosporine with pronounced nephro- and neurotoxicity.

Topical Ocular Dorzolamide (Trusopt)

Primary Use: Treatment of glaucoma.

Side Effects:
Bitter metallic-like taste.
Increased salivation.
Tongue and perioral numbness and edema.
Various gastrointestinal complaints, such as nausea, abdominal cramping, heartburn and upset stomach (occuring in up to 10% of patients.)
Rare: headaches, fatigue, insomnia, depression.

Topical Ocular Prostaglandin Analogs
Travoprost (Travatan), Latanoprost (Xalatan), Bimatoprost (Lumigan), Unoprostone isopropyl (Rescula)

Primary Use: Pressure-lowering agents, singularly or as an additive.

Side effects:
Increased iris pigmentation, especially in irides brown at the pupillary border and hazel or blue peripherally, with greatest color change in relatively hypopigmented irises.
Increased pigmentation due to increased melanin within each melanocyte, rather than hyperplasia.
Increased pigmentation of eyelashes and periorbital skin. Some skin hypopigmentation has been reported, but cannot as yet prove this is drug-related.
Eyelash curling.
Increased hair growth in not only the eyelashes, but also adjacent adnexal hair.
Low-grade iritis or uveitis, especially in patients with prior history of uveitis or incisional ocular surgery.
In glaucoma patients with a history of uveitis, latanoprost may cause an increase in intraocular pressure and a recurrence of intraocular inflammation.
Macular edema - including cystoid macular edema. Associated usually with uveitis.
Most common in aphakic eyes, especially with torn posterior capsules. Also more common in patients with known risks for macular edema.
If long-term use, may cause pigmentary glaucoma in younger patients.
May aggravate herpes simplex keratits and periocular herpes simplex dermatitis.
May cause migraine headaches.
May cause iris cysts.
May impair precorneal tear film stability.

Overview comparison of ocular side effects of these 4 prostaglandin analogs:
Probably no known systemic side effects to date.
Bimatoprost and travoprost have the highest frequency and severity of hyperemia and eyelash growth, compared to latanoprost and timinol.
Frequency of color darkening between bimatoprost, travoprost and latanoprost is the same.
Unoprostone can produce punctate keratopathy.
More headaches reported with latanoprost than with bimatoprost.

Systemic side effects:
Flulike symptoms (abdominal cramps, malaise and URI).
Four reports of aggravated asthma.
Question of increased migraine headaches.
Rare reports of angina, arterial hypertension, or tachycardia.

Appears to be a very safe drug systemically, but no long term studies have been accomplished at this time.

Supplements

      The following supplements have been found to have a wide range of adverse ocular side effects ranging from dry eye to retinal hemorrhages and transient visual loss: ginkgo biloba, Echinacea purpurea, chamomile, licorice, canthaxanthine, Datura (jimson weed), niacin and vitamin A. This was reported by Frederick W. Fraunfelder, M.D., (Oregon Health & Science University researcher) to the World Health Organization, the Food and Drug Administration, and the National Registry of Drug-Induced Ocular Side Effects. For more information, see the October 2004 issue of the American Journal Ophthalmology.