Ocular ADRs

C.V.S. drugs
_ Digitalis: Disturbance of colour vision, scotomas
_ Quinidine: Optic neuritis (rare)
_ Thiazides: Xanthopsia (yellow vision), Myopia
_ Carbonic anhydrase inhibitors: Ocular hypotony, Transient myopia
_ Amiodarone: Corneal deposits
_ Oxprenolol: Photophobia, Ocular irritation

G.I.T. drugs
_ Anticholinergic agents: Risk of angle-closure glaucoma due to mydriasis, Blurring of vision due to cycloplegia (Occasional).

C.N.S. drugs
_ Barbiturates: Extraocular muscle palsies with diplopia, Ptosis, Cortical blindness
_ Chloral hydrate: Diplopia, Ptosis, Miosis
_ Phenothiazines: Deposits of pigment in conjunctiva, cornea, lens and retina, Oculogyric crisis
_ Amphetamines: Widening of palpebral fissure, Dilatation of pupil, Paralysis of ciliary muscle with loss of accommodation
_ Monoamine oxidase inhibitors: Nystagmus, Extraocular muscle palsies, Optic atrophy
_ Tricyclic agents: Pupillary dilatation (glaucoma risk), Cycloplegia
_ Phenytoin: Nystagmus, Diplopia, Ptosis, Slightblurring of vision (rare)
_ Neostigmine: Nystagmus, Miosis
_ Morphine: Miosis
_ Haloperidol: Capsular cataract
_ Lithium carbonate: Exophthalmos, Oculogyric crisis
_ Diazepam: Nystagmus.


Female sex hormones
_ Retinal artery thrombosis
_ Retinal vein thrombosis
_ Papilloedema
_ Ocular palsies with diplopia
_ Nystagmus
_ Optic neuritis and atrophy
_ Retinal vasculitis
_ Scotomas
_ Migraine
_ Mydriasis
_ Cyloplegia
_ Macular oedema

_ Cataract (posterior subcapsular)
_ Local immune suppression causing susceptibility to viral (herpes simplex), bacterial and fungal infections
_ Steroid-induced glaucoma

_ Chloramphenicol: Optic neuritis and optic atrophy
_ Streptomycin: Optic neuritis
_ Tetracycline: Pseudotumour cerebri, Transient myopia

_ Macular changes (Bull’s eye maculopathy)
_ Central scotomas
_ Pigmentary degeneration of the retina
_ Chloroquine keratopathy
_ Ocular palsies
_ Ptosis
_ Electroretinographic depression

_ Diiodohydroxy quinoline: Subacute myelo optic neuropathy (SMON), optic atrophy

Chemotherapeutic agents
_ Sulfonamides: Stevens-Johnson syndrome
_ Ethambutol: Optic neuritis and atrophy
_ Isoniazid: Optic neuritis and optic atrophy

Heavy metals
_ Gold salts: Deposits in the cornea and conjunctiva
_ Lead: Optic atrophy, Papilloedema, Ocular palsies

Chelating agents
_ Penicillamine: Ocular pemphigoid, Ocular neuritis, Ocular myasthenia

Oral hypoglycemic agents
_ Chloropropamide: Transient change in refractive error, Diplopia, Stevens-Johnson syndrome

Vitamin A
_ Papilloedema
_ Retinal haemorrhages
_ Loss of eyebrows and eyelashes
_ Nystagmus
_ Diplopia and blurring of vision
Vitamin D
_ Band-shaped keratopathy

Antirheumatic agents
_ Salicylates: Nystagmus, Retinal haemorrhages, Cortical blindness (rare)
_ Indomethacin: Corneal deposits
_ Phenylbutazone: Retinal haemorrhages

- compiled & published by Dr Dhaval Patel MD AIIMS