11 Medications That Hurt Your Eyes | Tieumy Nguyen, PharmD | RxEconsult
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Medications That Reduce Vision Category: Pharmacotherapy by - March 16, 2014 | Views: 21806 | Likes: 2 | Comment: 0  

Medications and eye side effects

Common Drugs that Affect Vision

Many medications cause minor visual side effects that resolve without treatment. In some situations, minor symptoms may be signs of severe vision-threatening conditions. For instance, any drug that blocks the activity of a chemical known as acetylcholine may worsen glaucoma. The most common symptoms are dry eyes or headache, often followed by nausea and vomiting. These symptoms are severe enough to cause an individual to see an eye care doctor. Many of these side effects can be reversed with early detection. Therefore, it is very important that clinicians and patients are aware of the potential effects from any medications in order to prevent serious eye disorders.

Amiodarone (Cordarone) is used to treat irregular heartbeats and restore normal heart rhythm.

Up to 10% of patients taking amiodarone develop visual disturbances such as blurred vision, photosensitivity, and dry eyes. Optic neuropathy (optic nerve damage) or optic neuritis (inflammation of the optic nerve) occur in about 2% of patients who take amiodarone. Symptoms of optic neuropathy include decreased vision, decreased color vision and visual defects.  Corneal deposits leading to vision loss occur in at least 70 % of patient on amiodarone.

Prevention: Regular eye exams are recommended in all patients taking amiodarone. Call your doctor right away if you have visual disturbances.

Antimalarial medications such as chloroquine (Aralen) and hydroxychloroquine (Plaquenil) are commonly used to prevent and treat malaria. They are also used to treat rheumatoid arthritis and lupus. While it is not common, some people taking chloroquine or hydroxychloroquine long-term or high dose treatment can develop retinal damage resulting in vision loss. The effects can include blurred vision, corneal deposits, night blindness, and difficulty reading.

Prevention:  Eyes should be examined before starting these medications. All patients receiving these medications for long periods of time or at high doses should receive regular eye exams.

Corticosteroids are used to treat seasonal allergies, asthma, other respiratory conditions, and several types of inflammatory conditions.Visual impairments such as blurred vision and inflammation of optic nerve have been reported with prolonged use of inhaled, oral or topical corticosteroids.

Prevention:  Patients receiving corticosteroids for prolonged periods should have regular eye exams to check for glaucoma and report any visual changes or eye related side effects. 

Digoxin (Lanoxin) is used for treating congestive heart failure and irregular heartbeats.

Digoxin can cause visual disturbances such as blurred vision, yellow or green vision, and reduce visual acuity. Visual symptoms most often occur in patients with digoxin toxicity. Symptoms resolve after stopping digoxin or reducing digoxin blood levels.

Prevention: Call your doctor if you have a decrease in vision or eye pain.

Ethambutol (Myambutol) is an antibiotic used for treatment of tuberculosis (TB). This medication can affect the optic nerve, decreasing visual acuity and causing loss of color recognition.  These visual changes are related to dose and are reversible upon discontinuation of ethambutol. 

Prevention: Call your doctor if you have any vision changes. Patients should receive an eye exam before starting treatment periodically thereafter. Monthly eye exams are recommended for individuals receiving doses greater than 15 mg/kg/day.

Phenothiazines such as chlorpromazine (Thorazine) and thioridazine (Mellaril) are used to treat nervous and mental conditions. These medications can cause ocular changes such as change in color vision, difficulty seeing at night, and blurred vision. Other adverse eye effects that have been reported include retinopathy and cataract. Development of these side effects depends on the dose and the duration of treatment.

Prevention: Baseline and regular eye exams are recommended. Patients should notify their doctor right away if the notice visual disturbances. Chlorpromazine and thioridazine should be stopped it there are any vision changes.                                                             

Phosphodiesterase-5 inhibitors are used to treat erectile dysfunction in men. They work by increasing penile blood flow and decreasing penile blood outflow. Examples include sildenafil (Viagra), tadalafil (Cialis) and Vardenafil (Levitra). These medications cause sensitivity to light, blurred vision, and blue vision. These symptoms usually occur within 24 hours of use and are reversible. All phosphodiesterase-5 inhibitors can cause non-arteritic ischemic optic neuropathy (NAION means a lack of blood flow to the optic nerve) which can result in permanent vision loss. Risk factors for development of NAION include age over 50 years, diabetes, hypertension, hyperlipidemia, coronary artery disease, and smoking. 

Prevention: Any changes in vision should be reported immediately.

Tamoxifen (Nolvadex) is used to treat breast cancer. This drug works by blocking the activity of estrogen produced in the body. Adverse effects such as blurred vision, decreased color vision perception, corneal changes, and risk for cataracts have been associated with tamoxifen use.

Prevention: You should be examined by your doctor before taking this medication and every two year. Call your doctor if have any visual symptoms.

Tamsulosin (Flomax) is used to treat benign prostatic hyperplasia (BPH), which is an enlarged prostate and a common condition in men. Tamsulosin can cause intraoperative floppy iris syndrome (IFIS) which is a complication that occurs during cataract surgery. The risk is almost 100% in patients taking tamsulosin. Even if tamsulosin is stopped for 5 weeks to 9 months before surgery, the risk of IFIS still persists.

Prevention: Patients taking tamsulosin should inform their ophthalmologist prior to cataract surgery so that proper surgical techniques are used in order to prevent complications.

Telithromycin (Ketek) is used for treating bacterial infections. Visual adverse effects such as blurred vision, double vision, and difficulty focusing occur in up to 2% of patients. About 65% of the events occur after the first dose or second dose. Some symptoms may resolve while others persist through the full course of treatment. Women and patients under the age 40 have a higher chance of developing visual adverse events.

Prevention: Patients should inform their treating physician about any sudden changes in vision.

Topiramate (Topamax) is used for treating and preventing seizures. It also prevents headaches and migraines. Angle-closure glaucoma has been reported following a course of topiramate. Elevation in intraocular pressure typically occurs within one month of beginning therapy. Topiramate should be stopped if vision problems develop. Blurred vision, headache, nausea and vomiting are additional side effects from topiramate. Optic neuritis has been reported, but is not common.

Prevention: Patients should contact their doctor immediately if they develop eye pain or visual disturbances.

References

McGwin G Jr, Vaphiades MS, Hall TA, Owsley C. Non-arteritic anterior ischemic optic neuropathy and the treatment of erectile dysfunction. Br J Ophthalmol. 2006;90:154-157

Santaella RM, Fraunfelder FW. Ocular adverse effects associated with systemic medications. Drugs 2007;67:75-93

Kapoor KG, Mirza SN, Gonzales JA, Gibran SK. Visual loss associated with tacrolimus: Case report and review of the literature. Cutan Ocul Toxicol 2010;29(2):137-139

Li J, Tripathi RC, Tripathi BJ. Drug-induced ocular disorders. Drug Saf 2008;31:127-41

Bell CM, Hatch WV, Fischer HD, et al. Association between tamsulosin and serious ophthalmologic adverse events in older men following cataract surgery. JAMA 2009;301:1991-6

Lawrenson JG, Kelly C, Lawrenson AL, Birch J. Acquired colour vision deficiency in patients receiving digoxin maintenance therapy. Br J Ophthalmol 2002;86:1259-61

 



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