Ocular Side Effects of Systemic Drugs

When are ocular effects from systemic meds bilateral?

ALWAYS (may be asymmetrical)

What affect do anti-cholinergic have on tear production? How?

Decrease tear production

Decrease glandular secretions

What affect do oral anti-histamines have on tear production? How?

Decrease tear production

due to anti-ash side effects

What affect do decongestants have on tear production?

decrease tear production

What affect do TCAs and SSRIs have on tear production?

decrease tear production

What kind of drugs are Zoloft, Lexapro, Prozac, and Celexa?

SSRIs

What affect do anti-parkinsons drugs have on tear production?

decreases tear production

What effect do oral b-blockers have on tear production? How?

Decrease tear production

Decrease lysozyme & Ab within the tears

What effect does Isotretinoin (vit A analog for acne) have on tear production?

Can induce severe dry eye & CL intolerance

What effect do diuretics have on tear production? How?

decrease tear production by decreasing overall fluid available

What effect does proton pump inhibitors have on tear production?

decrease tear production

What effect does oral contraceptives have on tear production?

decreases tear production

What effect does Oxsoralen (for psoriasis) have on tear production?

decreases tear production

What type of drugs are Lasix, HCTZ?

diuretics

What type of drugs are Prilosec, protonix?

PPIs

What drugs increase tear production?

Sjogrens meds:

Salagen (pilocarpine)

Evoxac (Cevimeline)

What is vortex keratopathy?

epi + sub-epi deposits that usually go away after discontinuation of med

How does Salagen (pilocarpine) & Evoxac (cavimeline) increase tear production?

direct acting cholinergics

How does vortex keratopathy affect VAs?

doesn't

3 drugs that induce Vortex Keratopathy?

Amiodarone (cardiac arrhythmia)

Plaquenil (hydroxychloroquine) (RA and Lupus), rare in current doses

Gold Salts (RA, not used anymore)

What does Gold Salts cause?

chrysalis: gold deposits in posterior stroma

What effect on the cornea does Blenrep (for multiple myeloma) have?

degrades corneal epi (severe SPK, corneal ulceration, severe dry eye)

What effect on the cornea does Chlorpromazine (anti-psychotic) have on the cornea?

endothelial deposits, though rare

What systemic drugs induce uveitis?

Rifabutin (TB)

Bisphosphonates

What is the most common ocular side effect seen with bisphosphonates?

conjunctivitis (Self-limiting)

What drug causes floppy iris syndrome? What is its mechanism of action?

Tamsulosin (Flomax)

alpha-1 antagonist, blocks alpha receptors on iris dilator

What BPH med can be used in younger patients that doesn't cause floppy eyelid syndrome?

Avodart (dutasteride)

What systemic drugs cause pupillary miosis?

anticholinesterases (anti-AchE)

opiates

Salagen + Evoxac

What is the MOA of Salagen + Evoxac?

direct cholinergic agonists

What systemic drugs cause mydriasis and cycloplegia (and therefore can close angle/increase IOP)?

anticholinergics

anti anxiety (valium, Xanax, SSRIs)

antidepressants (Cymbalta, Effexor)

What systemic drugs cause just mydriasis (without cycloplegia)?

amphetamines (weight loss)

cocaine/methamphetamines

ADD/ADHD meds

Wellbutrin (NDRI)

oral decongestants

What effect do anti anxiety (valium, Xanax, SSRIs) meds have on the pupil?

mydriasis (with cycloplegia)

What effect do anticholinergics have on the pupil?

mydriasis (with cycloplegia)

What effect do antidepressants (Cymbalta, Effexor) have on the pupil?

mydriasis (with cycloplegia)

What effect do oral decongestants have on the pupil?

mydriasis (without cycloplegia)

What systemic drugs increase IOP? How?

due to mydriasis: anticholinergics, anti-histamines, antidepressants, anti-anxiety, anti-psychotics, decongestants

decreases outflow: steroids

What systemic drugs can cause an anterior lenticular stellate opacity?

anti-psychotics:

Chlorpromazine

Seroquel

What affect on the cornea can Seroquel have?

endothelial deposits (rare)

What effect on the sclera/conj can Seroquel have?

bluish hue

What systemic drug can cause a PSC?

steroids

What drugs can increase myopia?

decrease BP: sulfonamides, carbonic anhydrase inhibitors, diuretics

Topamax

How does Topamax increase myopia?

causes swelling of the choroid and CB, causing accommodation of the lens up to 5D

What are the effects of Topamax on the eye?

myopic shift

decreased accommodative amplitude

shallow anterior chamber (risk of angle closure)

Does topamax cause permanent changes in RE?

no, reversible once discontinuing the drug

What oral medications decrease IOP?

B-blockers

Cardiac glycosides

THC

alcohol

How does plaquenil effect the eye?

vortex keratopathy

bulls eye maculopathy

How does plaquenil effect the retina?

can cause bulls eye maculopathy

Is bulls eye maculopathy permanent or temporary?

permanent, and can progress even after drug discontinuation

What patients are at a higher risk of developing bulls eye maculopathy while on plaquenil?

high daily dose (>5mg/kg)

long duration of use

renal disease

on tamoxifen

What must patients starting plaquenil get evaluated?

VAs

MAC-OCT

10-2 VF

What effect can tamoxifen have on the retina?

white-yellow opacities around the macula causing decreased VA + VF

What effect can fingolimod (gilyena) have on the retina?

Cystoid macular edema (CME) --> FAME (fingolimod associated macular edema)

What type of patients are at an increased risk fro developing CME while on fingolimod (gilyena)?

diabetic patients

What does fingolimod (gilyena) treat?

MS

How does FAME resolve?

with discontinuation of drug, faster with topical NSAID

How can Pentosan Polysulfate Sodium (PPS, aka Elmiron) effect the retina?

causes bilateral paracentral:

pale yellow deposits

hyperpigmentation paracentrally

causes nodular thickening of RPE

What symptoms to patients with Pentosan Polysulfate Sodium (PPS, aka Elmiron) induced retinal toxicity have?

difficulty reading

prolonged dark adaptation