Ocular side effects of systemic medications
Medical hypothesis, discovery & innovation in optometry,
Vol. 5 No. 4 (2024),
2 March 2025
,
Page 178-186
https://doi.org/10.51329/mehdioptometry213
Abstract
Background: Systemic medications, which are crucial for managing a wide range of diseases from hypertension and diabetes to infections and cancers, can induce substantial ocular side effects. These effects impact visual function and quality of life, necessitating awareness and monitoring by healthcare professionals. The current review summarizes the range and mechanisms of these ocular toxicities.Methods: This narrative review was derived from a targeted literature search using major electronic databases including PubMed/MEDLINE, Embase, Scopus, and Google Scholar. Keywords related to ocular side effects of systemic medications were utilized to identify relevant studies published from January 1, 2000, to December 30, 2024. The included articles pertained to ocular manifestations of systemic drug use, their mechanisms of toxicity, and associated management strategies.
Results: This study identified notable ocular side effects related to various systemic medications. Amiodarone was consistently linked to corneal deposits and colored halos, prompting recommendations for regular eye examinations. Isotretinoin was frequently associated with dry mucous membranes and blepharoconjunctivitis. Chloroquine and hydroxychloroquine were found to cause corneal changes and irreversible retinal damage with prolonged use. Studies of allopurinol presented conflicting evidence regarding its relationship with cataract risk. Corticosteroid use was associated with cataract formation and potential elevation of intraocular pressure. Ethambutol has been identified as a potential cause of optic neuritis. Topiramate was linked to acute angle-closure glaucoma, particularly early in treatment. Anticholinergic drugs can impact various parts of the eye. They cause ciliary muscle relaxation, leading to temporary blurred vision. This loss of accommodation, also known as “iatrogenic presbyopia,” results from paralysis of the ciliary muscle. Phosphodiesterase type 5 inhibitors, such as sildenafil, may cause pupil dilation, redness, dryness, blurred vision, and temporary cyanopsia. Additionally, patients taking vigabatrin may experience progressive constriction of the visual fields, necessitating regular visual field assessments. Epidemiological studies indicate that approximately 15% of patients taking systemic medications experience dry eye syndrome. These findings underscore the diverse range and impact of drug-induced ocular toxicities. However, vigilant monitoring and prompt management can help mitigate vision-threatening complications and preserve patients’ visual health. Addressing these ocular side effects requires strong interdisciplinary communication among ophthalmologists, optometrists, primary care physicians, and other specialists.
Conclusions: The wide range of ocular manifestations of systemic medication use emphasizes the importance of monitoring patients for these side effects. Collaborative management by eye care professionals and prescribing physicians is vital to mitigate risks. Further research must focus on the mechanisms of drug-induced ocular toxicity and developing effective preventive measures.
Keywords:
- side effects
- ophthalmic absorption
- vision
- corneas
- toxic potential
- optometries
- ophthalmologist
- interdisciplinary communications
- multidisciplinary health team
- interdisciplinary health team
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5. Ahmad R, Mehta H. The ocular adverse effects of oral drugs. Aust Prescr. 2021 Aug;44(4):129-136. doi: 10.18773/austprescr.2021.028. Epub 2021 Aug 2. Erratum in: Aust Prescr. 2021 Oct;44(5):177. doi: 10.18773/austprescr.2021.045. PMID: 34421178; PMCID: PMC8377292.
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7. Wang AG, Cheng HC. Amiodarone-Associated Optic Neuropathy: Clinical Review. Neuroophthalmology. 2016 Nov 18;41(2):55-58. doi: 10.1080/01658107.2016.1247461. PMID: 28348626; PMCID: PMC5354097.
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11. Neudorfer M, Goldshtein I, Shamai-Lubovitz O, Chodick G, Dadon Y, Shalev V. Ocular adverse effects of systemic treatment with isotretinoin. Arch Dermatol. 2012 Jul;148(7):803-8. doi: 10.1001/archdermatol.2012.352. PMID: 22508771.
12. Brzezinski P, Borowska K, Chiriac A, Smigielski J. Adverse effects of isotretinoin: A large, retrospective review. Dermatol Ther. 2017 Jul;30(4). doi: 10.1111/dth.12483. Epub 2017 Mar 14. PMID: 28295859.
13. Elshafie M, Srour A, El-Ansarey H, Abdel-Kader M, Kabbash I, Mashaly M. Dermatologists' Knowledge and Attitude Toward Isotretinoin Ocular Side Effects in Egypt. Clin Cosmet Investig Dermatol. 2021 Sep 18;14:1295-1301. doi: 10.2147/CCID.S327870. PMID: 34566419; PMCID: PMC8457441.
14. Ruiz-Lozano RE, Hernández-Camarena JC, Garza-Garza LA, Bustamante-Arias A, Colorado-Zavala MF, Cardenas-de la Garza JA. Isotretinoin and the eye: A review for the dermatologist. Dermatol Ther. 2020 Nov;33(6):e14029. doi: 10.1111/dth.14029. Epub 2020 Aug 12. PMID: 32683764.
15. Karalezli A, Borazan M, Altinors DD, Dursun R, Kiyici H, Akova YA. Conjunctival impression cytology, ocular surface, and tear-film changes in patients treated with systemic isotretinoin. Cornea. 2009 Jan;28(1):46-50. doi: 10.1097/ICO.0b013e318183a396. PMID: 19092405.
16. Abdollahi M, Shafiee A, Bathaiee FS, Sharifzadeh M, Nikfar S. Drug-induced toxic reactions in the eye: an overview. J Infus Nurs. 2004 Nov-Dec;27(6):386-98. doi: 10.1097/00129804-200411000-00004. PMID: 15586102.
17. Kychygina A, Cassagne M, Tauber M, Galiacy S, Paul C, Fournié P, Simon M. Dupilumab-Associated Adverse Events During Treatment of Allergic Diseases. Clin Rev Allergy Immunol. 2022 Jun;62(3):519-533. doi: 10.1007/s12016-022-08934-0. Epub 2022 Mar 11. PMID: 35275334.
18. Ebeid WM, El-Shazly AAE, Kamal NM, Fakhary EE, Mansour A, Ashour DM. New insights into amiodarone induced retinal and optic nerve toxicity: functional and structural changes. Ther Adv Ophthalmol. 2023 Sep 9;15:25158414231194159. doi: 10.1177/25158414231194159. PMID: 37701727; PMCID: PMC10493063.
19. Alshehri M, Joury A. Ocular Adverse Effects of Amiodarone: A Systematic Review of Case Reports. Optom Vis Sci. 2020 Jul;97(7):536-542. doi: 10.1097/OPX.0000000000001534. PMID: 32697562.
20. Aminlari A, East M, Wei W, Quillen D. Topiramate induced acute angle closure glaucoma. Open Ophthalmol J. 2008 Mar 28;2:46-7. doi: 10.2174/1874364100802010046. PMID: 19478906; PMCID: PMC2687928.
21. Al Owaifeer AM, AlSultan ZM, Badawi AH. Topiramate-induced acute angle closure: A systematic review of case reports and case series. Indian J Ophthalmol. 2022 May;70(5):1491-1501. doi: 10.4103/ijo.IJO_2134_21. PMID: 35502014; PMCID: PMC9333044.
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