Ocular Side Effects of Systemic Drugs

Question 1

whorl keratopathy

Answer 1

F CHAI T + R

chloroquine, hydroxychloroquine, amiodarone, tamoxifen, indomethacin

Fabry’s disease, Rho kinase inhibitors

Question 2

dry eye disease

Answer 2

all drugs preserved with BAK, including topical ophthalmic glaucoma medications

Question 3

superficial punctate keratitis (SPK)

Answer 3

isotretinoin (Accutane), topical ophthalmic aminoglycosides (Tobradex)

Question 4

endothelial/Descemet membrane pigmentation, also on lens and retina

Answer 4

“-azine” drugs

chlorpromazine, thioridazine, promethazine (Phenergan)

Question 5

stromal gold deposits

Answer 5

gold salts can result in yellow-brown deposits between the stroma and Descemets (ocular chrysiasis)

Question 6

delayed corneal healing

Answer 6

topical ophthalmic and oral corticosteroids

Question 7

Amiodarone

Answer 7

an anti-arrhythmic drug that can cause whorl keratopathy (epithelium), anterior subcapsular lens deposits, and NAAION (1-2% of cases)

Question 8

anterior subcapsular effects/cataracts

Answer 8

“May trigger ant. cataract” = miotics (vacuoles), thioridazine, amiodarone (deposits), chlorpromazine

Question 9

posterior subcapsular cataracts

Answer 9

corticosteroids

Question 10

Isotretinoin (Accutane)

Answer 10

blepharoconjunctivitis, dryness, lid edema, loss of colour vision, nyctalopia, intracranial hypertension

Question 11

subconjunctival hemorrhage

Answer 11

NSAIDs, warfarin (Coumadin), clopidogrel (Plavix), dipyridamole (Persantine), Sildenafil (Viagra)

Question 12

sulfonamides

Answer 12

Stevens-Johnson syndrome and lid edema

Question 13

tetracyclines

Answer 13

pigmented cysts on the conjunctiva, pseudotumor cerebri, papilledema

Question 14

conjunctival hyperemia

Answer 14

Sildenafil, prostaglandin analogues

Question 15

Tamiflu

Answer 15

(antiviral for influenza) can cause conjunctivitis in 1% of pts

Question 16

decrease tear secretion

Answer 16

anticholinergics, TCAs, antihistamines, phenothiazines, isotretinoin, beta-blockers, hormone therapies (HRT, contraceptives), ADHD meds (methylphenidate, dextroamphetamine), diuretics (HCTZ, furosemide, triamterene)

Question 17

miosis

Answer 17

opiates (morphine, heroine, codeine), acetylcholinesterase inhibitors

Question 18

mydriasis

Answer 18

anticholinergics, antihistamines, SSRIs, SNRIs, TCAs, phenothiazines, benzos, dopamine agonists

Question 19

nystagmus

Answer 19

phenytoin (Dilantin), phenobarbital (Luminal), salicylates (NSAIDs), topiramate

Question 20

diplopia

Answer 20

antidepressants, antianxiety agents, phenytoin (Dilantin), pseudoephedrine

Question 21

smooth pursuit impairment

Answer 21

alcohol

Question 22

oculogyric crisis

Answer 22

phenothiazines, cetirizine (Zyrtec)

Question 23

intraoperative floppy iris syndrome

Answer 23

a1 blockers (tamsulosin, terazosin, prazosin)

Question 24

blue sclera

Answer 24

corticosteroids, minocycline

Question 25

topiramate (Topamax)

Answer 25

secondary angle closure, choroidal swelling moves the iris forward into apposition with the TM

Question 26

Digoxin

Answer 26

retrobulbar optic neuritis, B/Y colour defects, entoptic phenomena

Question 27

Ethambutol

Answer 27

optic neuritis (typically retrobulbar and bilateral)

Question 28

NAION

Answer 28

Sildenafil, vardenafil, sumatriptan, amiodarone “VIA” - viagra, imitrex (sumatriptan), amiodarone

Question 29

optic neuritis

Answer 29

“DICE” digoxin, isoniazid, chloramphenicol, contraceptives, ethambutol streptomycin, sulfonamides, methotrextrate

Question 30

oral contraceptives

Answer 30

decreased tear secretion, optic neuritis, papilledema, pseudotumor cerebri, vasculopathy (RAOs and RVOs), retinal hemorrhage, intracranial hypertension

Question 31

chloroquine

Answer 31

bull's eye maculopathy

Question 32

epinephrine

Answer 32

cystoid macular edema

Question 33

tamoxifen

Answer 33

white or yellow crystalline deposits (commonly in the macula) with or without macular edema, dry eye, cataracts, keratopathy

Question 34

thioridazine/chlorpromazine/promethazine

Answer 34

pigmentary retinopathy that can have an appearance similar to bulls eye maculopathy, cataracts, whorl keratopathy, RP

Question 35

indomethacin

Answer 35

retinal hemorrhage, pigmentary changes (especially in the macula)

Question 36

talc

Answer 36

retinopathy (white, shiny emboli within arterioles)

Question 37

zidovudine (Retrovir) “-vudine” drugs

Answer 37

macular edema

Question 38

NSAIDs

Answer 38

subconjunctival hemes, retinal hemes

Question 39

drugs causing intracranial hypertension

Answer 39

tetracyclines, isotretinoin, oral contraceptives, nalidixic acid

Question 40

drugs that decrease IOP

Answer 40

systemic beta-blockers, cardiac glycosides (digoxin), alcohol, cannabinoids

Question 41

drugs that increase IOP

Answer 41

anticholinergics (atropine, scopolamine), antihistamines, TCAs, antipsychotics (phenothiazines), short-acting b2 agonists (albuterol, levalbuterol, terbutaline), pseudoephedrine, corticosteroids

Question 42

drugs that can cause pseudotumor cerebri/IIH

Answer 42

CATS: contraceptives, accutane, tetracyclines, synthroid (\<18yo)

Question 43

beta-blockers should be used cautiously in

Answer 43

diabetics as it can mask symptoms of fatal hypoglycemia (can also mask symptoms of hyperthyroid) myasthenia gravis

Question 44

“-zone” diabetic drugs

Answer 44

macular edema

Question 45

ribavirin (hep c therapy) +interferon

Answer 45

conjunctivitis, **R**D, **i**schemia (CWS), **b**leeding (retinal hemes), **a**rterial/**v**enous occlusions, and optic **n**euritis

Question 46

acute secondary angle closure glaucoma

Answer 46

topiramate, HCTZ, chlorothiazide

Question 47

myopic shift drugs

Answer 47

May Have To See Dimly miotics, HCTZ, topiramate, sulfa, diamox (CAIs)

Question 48

Stevens-Johnson syndrome

Answer 48

Sulfonamide, phenytoin, NSAIDs, penicillin, aspirin, barbiturates, isoniazid, tetracyclines, immunizing vaccinations

Question 49

pseudoephedrine

Answer 49

blurry vision, diplopia

Question 50

pigmentary retinopathy

Answer 50

chlorpromazine, thioridazine, indomethacin, promethazine

Question 51

promethazine

Answer 51

pigment x3 - corneal endo, lens, retinal pigment antihistamine (symp) effects - dry mouth, mydriasis, dry eyes, tachy cardia, etc.

Question 52

EOM palsies

Answer 52

Phenytoin