Healthy Sight Counseling and Individuals Taking Medications With Potential Ocular Side Effects

Category

Class

Examples

Adverse Ocular Effect(s)

Allergy

Antihistamines

Nonselective H₁-receptor Inhibitors:

• Benadryl® (diphenhydramine)
• Chlor-Trimeton® (chlorpheniramine)

• Pupillary changes
• Decreased vision
• Dry eye

Selective H₁-receptor Inhibitors:

• Claritin® (loratadine)
• Zyrtec® (cetirizine)

• Lacrimation
• Dry eye
• Contact lens discomfort

Corticosteroids

• Cortisone
• Hydrocortisone

• Cataract
• Elevated intraocular pressure
• Photophobia
• Mydriasis
• Decreased vision

Cardiovascular agents

Angiotensin converting
enzyme inhibitors

• Capoten® (captopril)
• Vasotec® (enalapril)

• Decreased vision
• Conjunctivitis
• Blepharoconjunctivitis
• Photosensitivity
• Angioedema of the eye and orbit

Antiarrhythmics

• Cordarone® (amiodarone)

• Photosensitivity
• Photophobia
• Keratopathy
• Optic neuropathy

Beta-receptor blockers

• Tenormin® (atenolol)
• Lopressor® (metoprolol)
• Inderal® (propranolol)
• Coreg® (carvedilol)
• Norvasc® (amlodipine)

• Reduced tear secretion
• Visual disturbances
• Erythema of the eyelids or conjunctiva
• Photophobia
• Nonspecific conjunctivitis
• Diplopia
• Urticaria

Calcium channel blockers

• Adalat®, Procardia® (nifedipine)
• Calan® (verapamil)

• Photosensitivity
• Decreased vision
• Periorbital edema
• Chemosis

Digitalis glycosides

• Lanoxin® (digoxin)
• Digitoxin

• Changes in color vision
• Entopic phenomena
• Sensitivity to glare

Diuretics

• HydroDIURIL® (hydrochlorothiazide)
• Lasix® (furosemide)

• Photosensitivity
• Myopia
• Reduced tear production
• Changes in color vision

Central nervous system agents

Antianxiety agents

• Xanax® (alprazolam)
• Ativan® (lorazepam)
• Valium® (diazepam)

• Diplopia
• Abnormal extra-ocular muscle movements
• Decreases in corneal reflex
• Conjunctivitis

Antidepressants

Selective serotonin reuptake inhibitors:

• Prozac® (fluoxetine)

• Mydriasis
• Photophobia

Tricyclic antidepressants:

• Amitriptyline
• Imipramine

• Mydriasis
• Cycloplegia
• Dry eyes
• Photophobia
• Photosensitivity

Central nervous system stimulants

Amphetamines:

• Dexedrine®
• Ritalin® (methylphenidate)
• Methamphetamine

• Mydriasis
• Decreased pupil reaction to light

Antipsychotic agents

• Thorazine® (chlorpromazine)
• Mellaril® (thioridazine)

• Mydriasis
• Increased incidence of cataract
• Corneal endothelial pigmentary changes

Anticonvulsants

• Neurontin® (gabapentin)
• Lamictal® (lamotrigine)
• Topamax® (topiramate)

• Diplopia
• Blurred vision
• Nystagmus

Hydantoins:

• Dilantin® (phenytoin)

• External ophthalmoplegia
• Diplopia
• Nystagmus

Dermatologic agents

Retinoids

• Accutane® (isotretinoin)

• Reduced vision
• Keratitis
• Corneal opacities
• Blepharoconjunctivitis
• Conjunctivitis
• Optic neuritis
• Dry eyes
• Photosensitivity
• Night blindness (permanent)

HIV/AIDS related agents

• Cytovene® (ganciclovir)

• Hypotony
• Retinal detachment
• Increased intra-ocular pressure
• Cataract (ganciclovir implants)

• Retrovir® (zidovudine)
• Combivir® (lamivudine/zidovudine)

• Cystoid macular edema
• Hypertrichosis
• Hyperpigmentation of the eyelids and conjunctiva

• Videx® (didanosine)

• Retinal toxicity, mottling of the retinal pigment
• epithelium and atrophy in the mid-periphery of the fundi
• Optic neuritis
• Night blindness

Neoplastic agents

Antiestrogen

• Nolvadex® (tamoxifen)

• Vision loss
• Retinal edema
• Retinal hemorrhage
• Optic disc swelling
• Cystoid macular edema
• Retinal pigment epithelial changes

Alkylating agents

• Myleran® (busulfan)

• Posterior subcapsular cataract
• Keratoconjunctivitis sicca
• Loss of eyelashes or eyebrows

• BiCNU® (carmustine)

• Secondary glaucoma
• Internal ophthalmoplegia
• Optic neuritis

• Cisplatin (cisplatinum)

• Ipsilateral vision loss
• Blurred vision
• Color deficiency
• Disc edema

Antimetabolite

• 5-FU (fluorouracil)

• Blepharitis
• Conjunctival irritation
• Cicatricial reaction in conjunctiva, punctum, canaliculus, and lacrimal sac that can result in irreversible scarring

Folic acid antagonists

• Methotrexate

• Blepharitis
• Periorbital edema
• Conjunctival hyperemia
• Increased lacrimation
• Photophobia

Antibiotic antineoplastic agents

• Blenoxane® (bleomycin)
• Adriamycin PFS/RDF (doxorubicin)

• Conjunctivitis
• Lacrimation
• Blurred vision

• Mutamycin® (mitomycin)

• Corneal and scleral melts
• Permanent porcelainization of the conjunctiva and sclera

Hormones and agents affecting
hormonal mechanisms

Bisphosphonates

• Fosamax® (alendronate)
• Didronel® (etidronate)
• Aredia® (pamidronate)
• Actonel® (risedronate)

• Uveitis
• Nonspecific conjunctivitis
• Ocular pain
• Blurred vision
• Scleritis

Erectile dysfunction agents

• Viagra® (sildenafil)
• Levitra® (vardenafil)
• Cialis® (tadalafil)

• Color vision effects
• Increased light sensitivity
• Blurred vision
• Conjunctival hyperemia
• Ocular pain

Analgesic agents

Nonsteroidal
anti-inflammatory drugs

• Aspirin
• Ibuprofen

• Transient blurred vision
• Refractive error changes
• Diplopia
• Photophobia
• Dry eyes
• Color vision problems

Anticholinergics

• Atropine

• Mydriasis
• Absence of reaction to light

• Transderm Scop® (scopolamine)

• Mydriasis

Antimicrobial agents

Fluoroquinolones

• Ciprofloxacin
• Norfloxacin
• Ofloxacin

• Glare phenomenon
• Photophobia
• Photosensitivity

Herbal products and nutritional
Supplements

• Henbane (Hyoscyamus niger)
• Kava kava (Piper methysticum)

• Cycloplegia

• Chamomile (Matricaria chamomilla)
• Propolis

• Conjunctivitis

• Niacin

• Dry eyes

• Bitter orange (Citrus aurantium)

• Phototoxicity

• Henbane (Hyoscyamus niger)
• Ginkgo (Ginkgo biloba)

• Hyphema
• Retinal hemorrhage

• Mandrake (Mandragora officinarum)
• Valerian (Valeriana officinalis)

• Mydriasis

• St. John’s wort (Hypericum perforatum)

• Photosensitivity