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Appendix 35-1

Common and Critical Ocular Adverse Drug Reactions From Systemic Drugs—cont’d

	OADR (including WHO classification	Prevention/Risks/
Drug	of causality, where available)	Considerations	Management

irregularities; HRT for	(compared to estrogen/progesterone		Dry eye treatment with topical artificial
symptoms of menopause)	and estrogen/progesterone with		tears; hot compresses/lid care routines,
	androgens) showed the greatest		environment modification, immunomod-
	aqueous deficiency. (Increasingly,		ulatory drugs and nutritional supplements.
	IOP decrease in the estrogen-only		(Note that estrogen or androgen-based
	group only.)		drops may be a promising new treatment.)
chlorpromazine (Thorazine)	“Certain” corneal pigment (white,	UV protection is advised.	Lens:
(phenothiazine anti-psychotic)	yellow, brown, or black); anterior	Grade I: Fine opacities on the anterior	•	No lens changes noted (0% of

	subcapsular cataract; all rarely causing	lens surface within the pupil.		patients) if cumulative dose is <500 g,
	visual symptoms of haziness or halos;	Grade II: Dot-like, opaque pigment;		but exceeds 90% with cumulative

	oculogyric crisis	stellate pattern forms.		doses of >2,500 g.
	(NOTE: chlorpromazine is the primary	Grade III: Larger granules of pigment	•	800 mg/day may reach OADRs in

	phenothiazine known to cause these	(white, yellow, tan) with an		14–20 months, but if >2,000 mg/day,
	adverse effects.)	anterior subcapsular stellate pattern.		in 6 months
	Changes are dose-related.	Grade IV:A star pattern, easily	Cornea:

		recognized with a penlight.	• 1% on 300 mg/day, 12% on
		Grade V: Central, lightly pigmented,		2,000 mg/day

		pearl-like, opaque mass surrounded	Monitor structures annually. If symptoms
		by smaller clumps of pigment.	develop, consider reducing dose in
			conjunction with prescribing doctor, or
			changing to a non-phenothiazine drug.
thioridazine (Mellaril)	“Certain” pigmentary retinopathy (mild	Baseline examination with visual acuity,	Follow-up dilated fundus examinations
(phenothiazine anti-psychotic)	peppery pigment to focal confluent areas,	central VFs, CV, dilated fundus	recommended every 2–4 months
	to focal atrophy of the choriocapillaris)	examination (with photography)	initially and every 6 months thereafter
	leading to possibility of permanent reduced	is advised.	depending on dose and duration of drug
	visual acuity, CV, disturbances of dark	Retinopathy is dose-dependent:	administration.
	adaptation.	• few reports with dose <800 mg/day	Symptoms may precede fundus signs, so
			patient and care-givers should be advised
			of symptoms of toxicity. Drug should be
			discontinued promptly at the first sign
			of retinopathy. Progression may occur
			despite discontinuation.
All phenothiazines	All phenothiazines may show antimuscarinic	Ensure angles are not narrow such that	Regular comprehensive eye examinations
	adverse effects.This can include mydriasis	risk of acute or chronic angle closure	(see chlorpromazine and thioridiazine).
	and cycloplegia with subsequent decreased	is possible.
	vision.	Provide corrective lenses based
		on refractive findings, including
		accommodative dysfunction.

Medications Systemic to Reactions Drug Adverse Ocular 35 CHAPTER 756

		UV-protection is suggested and
		tinted lenses may improve comfort
		with dilated pupils.
quetiapine (Seroquel)	“Unlikely” cataracts.
(schizophrenia)
lithium	Jerk nystagmus (1° position and downgaze);	Patients on long-term lithium therapy
	blurred vision (especially in lateral gaze).	should have at least yearly
		comprehensive ophthalmic
		examinations.

8-methoxypsoralen (PUV-A	“Certain” cataracts;VA is usually unaffected.	Care should be taken to protect the
therapy)		eyes from UV radiation for at least
(treatment of vitiligo,		12–24 hours after therapy (including
psoriasis in combination		indoors as fluorescent light UV
with UV-radiation		radiation is still significant; especially
treatments)		in children, preexisting cataract).
talc (magnesium silicate)	“Certain” small, white, shiny particulate	Dose-related with retinopathy may
(associated with injection	emboli in the small arterioles and	be noted at ~9,000 tablets but
of particulate matter from	capillary bed, usually of the fovea.	consistently seen in patients who
crushed methylphenidate,	May also have macular edema, venous	have injected >12,000 tablets. Daily
heroin, cocaine tablets in	engorgement, flame-shaped hemorrhages,	tablet ingestion varies but can reach
water)	arterial occlusions (usually asymptomatic);	100 tablets/day.
	neovascular fronds at the edge of	Pulmonary consultation is required
	perfused and nonperfused retina may	as collateral vessels will be developed
	lead to vitreous hemorrhage and RD.	in the lungs to have allowed the
	These signs may cause corresponding	particles to enter the left side of the
	symptoms. Free-basing crack cocaine	heart to be transported to the organs
	can give “microtalc” retinopathy; which	of the body, including the eye.
	includes NFL defects with VF defects.

General OADRs

Comprehensive ophthalmic examination as per conventional routine.

Because downbeat nystagmus has neurologic significance and may be related to a variety of metabolic or drug-related causes, refer. The nystagmus may not resolve with reduction of dosage or drug cessation. Prolonged drug withdrawal, up to 6 months or even years, may be necessary to produce improvement.

Cataracts developed from PUV-A therapy are amenable to extraction.

Periodic examination to monitor for neovascularization of the retina and optic nerve should be undertaken, especially if drug abuse continues.

If i.v. drug abuse has ceased, then close monitoring may not be necessary. Treat neovascular changes with laser photocoagulation; vitreous hemorrhage with vitrectomy.

“Microtalc” retinopathy should be monitored as open angle glaucoma and may require IOP lowering agents to prevent continued VF loss.

	Dryness	Tearing

Drugs that cause ADRs to	Antimuscarinic agents: e.g., atropine, scopolamine	Adrenoceptor agonists: e.g., ephedrine
the Lacrimal System	Stimulants: e.g., methylphenidate, dextroamphetamine	Cholinergic agonists: e.g., pilocarpine, neostigmine
	Antihistamines: e.g., chlorpheniramine, brompheniramine,	Antihypertensive agents: e.g., clonidine, reserpine, hydralazine
	diphenhydramine	Antineoplastic agents: e.g., 5-fluorouracil
	Vitamin A analogs: e.g., isotretinoin, etretinate
	Vitamins: niacin
	β-Adrenoceptor blocking agents: e.g., atenolol, practolol,
	propranolol, timolol,
	Phenothiazines: e.g., chlorpromazine, thiroridazine

		Continued

757 Medications Systemic to Reactions Drug Adverse Ocular 35 CHAPTER

Appendix 35-1

Common and Critical Ocular Adverse Drug Reactions From Systemic Drugs—cont’d

		General OADRs

		Dryness		Tearing

		Antianxiety agents: e.g., chlordiazepoxide, diazepam
		Diuretics: e.g., hydrochlorothiazide
		Hormone therapies: Oral contraceptives, hormone
		replacement therapy
		Chemotherapeutic agents: e.g., methotrexate, carmustine
Drugs that cause		Mydriasis		Miosis
ADRs to the Pupil		Anticholinergic agents: e.g., scopolamine		Opiates: e.g., heroin, codeine, morphine
		Antihistamines: e.g., diphenhydramine		Anticholinesterases: e.g., neostigmine
		CNS stimulants: e.g., amphetamines, methylphenidate,
		cocaine
		CNS depressants: e.g., barbiturates, antianxiety agents
		Phenothiazines: e.g., chlorpromazine
Drugs that cause ADRs to		Nystagmus		Diplopia/Oculogyric crisis
Extraocular Muscle Movements		e.g., salicylates, phenytoin, antihistamines,		e.g., phenothiazines, antianxiety agents, antidepressants
		Gold salts, lithium, carbamazepine, barbiturates		e.g., certirizine (oculogyric crisis)
Drugs that cause		Myopia		Cycloplegia
ADRs to Refraction		e.g., sulfonamides, diuretics, carbonic anhydrase inhibitors,		e.g., chloroquine, phenothiazines, anticholinergics, antihistamines,
		isotretinoin, topiramate (sulfa-containing)		antianxiety agents, tricyclic antidepressants
Drugs that cause changes		Increased IOP		Decreased IOP
to Intraocular Pressure		e.g., anticholinergic agents, antihistamines, phenothiazines,		e.g., β-blockers, cardiac glycosides,
		tricyclic antidepressants, corticosteroids		cannabinoids, ethyl alcohol
		Some Common Herbal and Vitamin Therapies With OADRs

Herbal/Vitamin	OADR		Prevention		Management

Cannabinoids	“Certain” IOP lowering (25%), lasting 3–4 hours		Inquire of all patients if they are using		Symptoms are usually reversible with
			any nutritional supplements, vitamins.		recognition of the agent and discontinuing.
Herbals:	“Certain” crystalline retinopathy
Canthaxanthin
Herbals:	“Certain” allergic conjunctivitis
Chamomile
Herbals:	“Certain” mydriasis
Datura
Herbals:	“Probable” conjunctivitis
Echinacea purpurea
Herbals:	“Probable” spontaneous hyphema, retinal
ginkgo biloba	hemorrhage

Medications Systemic to Reactions Drug Adverse Ocular 35 CHAPTER 758

Herbals:	“Possible” vasospasm,VL associated with
licorice	migraine-like symptoms
Herbals:	“Probable” cystoid macular edema
niacin	“Possible” decreased vision, dry eyes, superficial
	punctate keratitis, discoloration of lids, lid
	edema, proptosis, loss of eyelashes/brows
Herbals:	“Certain” intracranial hypertension	Concomitant use of vitamin A with
vitamin A	(large doses)	other retinoids can show a
		potentiation of effect.

Discontinue vitamin A and other possible implicating medications. Initiate treatment for intracranial pressure decrease.

Note: OADRs = ocular adverse drug reactions; CV = color vision; VF = visual field; VL = vision loss; NFL = nerve fiber layer; IOP = intraocular pressure; NSAIDs = nonsteroidal anti-inflammatory drugs; TBUT = tear break-up time; CL = contact lens; IH = intracranial hypertension; RD = retinal detachment; NAION = nonarteritic ischemic optic neuropathy.

Adapted from:

Carnahan MD, Goldstein DA. Ocular complications of topical, periocular and systemic corticosteroids. Curr Opin Ophthalmol 2000;11:478–483. Fraunfelder FT, Fraunfelder FW, Randall JA. Drug-induced Ocular Side Effects, 5th ed. Boston: Butterworth-Heinemann; 2001.

Fraunfelder FW, Fraunfelder FT. Drug-related Adverse Effects of Clinical Importance to the Ophthalmologist. From American Academy of Ophthalmology, Course 444. 13 November 2006. Retrieved 10 April 2007 from www.aao.org/am_handouts_pdfs/444FarauX129.pdf.

Moorthy RS,Valluri S. Ocular toxicity associated with systemic drug therapy. Curr Opin Ophthalmol 1999;10:438–446.

Also, aFraunfelder FW, Fraunfelder FT. Drug-related Adverse Effects of Clinical Importance to the Ophthalmologist. From American Academy of Ophthalmology. October 16, 2005, bFraunfelder FW, Fraunfelder FT. Drug-related Adverse Effects of Clinical Importance to the Ophthalmologist. From American Academy of Ophthalmology. November 17, 2003, and cFraunfelder FW, Fraunfelder FT. Drug-related Adverse Effects of Clinical Importance to the Ophthalmologist. From American Academy of Ophthalmology, 2002. Retrieved 10 April 2007 from http://piodr.sterling.net/.

Medications Systemic to Reactions Drug Adverse Ocular 35 CHAPTER

759

Index

Note: Page numbers followed by f indicates figures; numbers followed t indicates tables.

A	Acetazolamide—cont’d	Adenoviral conjunctivitis, 451-454, 452f,
Abacavir, 206t	pharmacology of, 159-160, 161t	453f, 453t
Abbreviations used in	side effects of, 161-162, 162b	Adherence to therapy, 3, 59-60, 60b
prescriptions, 55t	Acetylcholine in myasthenia gravis,	Adie’s syndrome, 357-360
ABMD. See Anterior basement	372-373	diagnosis of, 358-360, 358b, 359f, 359t
membrane dystrophy	Acetylcholinesterase receptor, 372	etiology of, 357-358
Abrasion	Acetylcysteine, 555t	management of, 360
conjunctival, 479-480	in artificial tears, 271	Administration, drug. See Delivery
corneal, 44, 496-498, 496f, 497f	for superior limbic	system
Abuse	keratoconjunctivitis, 476	Adnexa in allergic disease, 550
adverse drug reactions and, 703	for tear augmentation, 429	Adrenal suppression, corticosteroid-
of cocaine	in vernal keratoconjunctivitis, 566	induced, 233
conjunctiva and, 711	Acetylsalicylic acid. See Aspirin	Adrenergic agonist
pupil and, 718	Acid injury, corneal, 509	apraclonidine as, 154-155
of topical anesthetic, 513-514	Acidosis, metabolic, 162	brimonidine as, 155-158, 156f, 157f,
Acanthamoeba keratitis, 215, 216t, 217,	Acinetobacter, 178t	158f
536-538, 537f, 538t	Acitretin, 751t	decongestants as, 249
Accessory lacrimal gland, 415	Acne rosacea, 190	Adrenergic innervation, 113-114
Accommodation	Acquired dacryocystitis, 433-434	Adrenergic mydriasis, 362, 363f
amplitude of, 6-7	Acquired immunodeficiency disease.	Adult-onset asthma, aspirin and, 100
drugs affecting, 720-722, 720b, 721f	See Human immunodeficiency	Advanced Glaucoma Intervention
residual, cycloplegics and, 346, 347	virus	Study, 695t
tropicamide and, 133-134, 135	Actinic keratosis, 405, 405f	Adverse drug reaction, 701-759
Accommodative esotropia	Actinomyces, 433	conjunctival, 711-713, 712t
cycloplegic agents for, 663-665	Actinomyces israelii, 451	corneal, 704-711, 704t
mitotics for, 665	Active ingredient, 28	counseling about, 61
Accommodative spasm, 169	Active transport, 26-27	determinants of, 702-704
Accutane, 751t	Actonel, 753t	diagnosis of, 704
Acetaminophen	Acular, 259, 554t	episcleral, 715-718, 716t
for child, 109t	for seasonal conjunctivitis, 561	of extraocular muscle, 719-720, 719t
clinical uses of, 103	Acular LS, 64b, 236t	on intraocular pressure, 722-725,
contraindications to, 103	Acute hemorrhagic conjunctivitis, 459	722b, 723t
pharmacology of, 102-103	Acute pain, 108-109, 109f	of lacrimal system, 713-715, 714t
side effects of, 103	Acute retinal necrosis, 620-621, 620f	lenticular, 704-711, 704t
vitamin C and, 300	Acyclovir	minimizing of, 7-9
Acetazolamide	for acute retinal necrosis, 621-622	to mitotic agents, 666
adverse effects of, 755t	clinical indications for, 202t	myopia as, 720-722, 721f
in angle-closure glaucoma, 693	for herpes simplex infection, 197,	optic neuropathy as, 736-741, 736t
clinical uses of, 160-161	198t-199t, 202t	prevention of, 741, 746
complications of, 77	for herpes simplex keratitis, 530	of pupil, 718-719, 718b
contraindications to, 162-163, 162b	for herpes zoster ophthalmicus,	reporting of, 742f-745f
dorzolamide and, 165	396, 532	retinal, 725-736. See also, Retina, drugs
myopia caused by, 720	for progressive outer retinal necrosis,	adversely affecting
pharmacokinetic properties of, 161t	625	risk disclosure about, 68-69

761

762	Index
Adverse drug reaction—cont’d		Allergic eye disease	Ampicillin, 180t
of scleral, 715-718, 716t		conjunctival, 239-240, 549-574, 550,	Ampicillin/sulbactam, 181-182
uveal, 715-718, 716t		556t-559t, 560-568	Amprenavir, 206t
WHO definitions of, 702t		atopic keratoconjunctivitis, 241,	Anacin, 104t
Advil, 102t		466-467, 466f, 549, 557t, 559t,	Analgesic, 97-111

Affordability of drug, 3, 4t	567-568, 567f	for child, 109-110, 109t
African-American patient	giant papillary, 561-564, 562t, 563f	mechanism of, 97-98
acetazolamide and, 163	mast cell stabilizers for, 255	narcotic, 104-108
uveitis in, 589	medrysone for, 228	nonnarcotic, 98-104
Agar, 441	seasonal, 550, 560-561, 560f	nonsteroidal anti-inflammatory drugs
Age	vernal keratoconjunctivitis, 564-566,	as, 100-102, 100b, 101t
adverse drug reaction and, 703	565f	salicylates as, 98-100, 99t
brimonidine effects and, 158f	cyclosporine A for, 241	strategies for using, 108-109, 109f
in Horner’s syndrome, 353	of eyelid, 568, 569t, 570-572	Anaprox, 102t
uveitis and, 589	atopic dermatitis as, 568, 570	Ancef, 184t
Agenerase, 206t	contact dermatitis as, 570-571,	ANCHOR Trial, 307, 638-639
Age-Related Eye Disease Study, 299, 300,	570b, 571f	Anecortave, 309-310
636, 637	urticaria as, 571-572	for age-related macular degeneration,
Age-related macular degeneration,	immunology of, 549-550	639
635-639, 635f, 636f. See also	Allergic shiner, 560	sub-Tenon’s injection of, 49
Macular disease	Alocril, 256t, 553t	Anemia
Agranulocytosis	Alomide, 256t, 553t	aplastic
antithyroid drug cay, 653	in seasonal conjunctivitis, 561	chloramphenicol causing, 192-193
methazolamide and, 164	Alpha-2 receptor agonist, 153-154	methazolamide and, 164
sulfonamides causing, 193-194	Alpha zone, 678, 678f	sulfonamides causing, 193-194
AIDS. See Human immunodeficiency	Alpha-adrenergic agonist, 690, 690t	hemolytic, sulfonamides causing,
virus	Alrex, 554t	193-194
Ainex, 751t	Alternaria, 520	Anesthesia
AK-Con, 248t	Amb a 1-immunostimulatory	abuse of, 513-514
AK-Homatropine, 127t	oligodeoxyribonucleotide	for cataract surgery, 603
AK-Pentolate, 127t	conjugate vaccine, 561	for chalazion incision and drainage,
Alamast, 256t, 553t	Amblyopia, 663-669	327, 327f
AlbalonVasocon Regular, 248t	atropine for, 128	complications of, 75
Albendazole, 630	cycloplegic agents for, 663-665	for eyelid lesion removal, 326-327, 326t
Alcohol	cycloplegic refraction in, 344	infiltrative injection technique for,
acetaminophen and, 103	mitotic agents for, 664-666	325-326, 326f
eye movement caused by, 720	paralytic agents in, 666-669, 667b	injectable, 86-87, 87t
intraocular pressure and, 724	Amblyopia Treatment Study, 664	local, 85-95. See also Local anesthetic
Alcohol gaze nystagmus test, 720	American Thyroid Association, 644	mechanism of action of, 98
Algorithm for pain management,	disease classification of, 645-646	presurgical evaluation and, 324-325
109f	Amikacin, 190	regional, 323-324
Alkali injury, corneal, 509, 511f	clinical uses of, 189	in scleritis, 581
Alkylating agent for uveitis, 595	endophthalmos and, 606	topical, 87-90, 88t, 89f, 319-328.
All Clear AR, 248t	Aminoglycoside, 187-190	See also Topical anesthesia
Allegra, 552t	Amiodarone, adverse reaction to, 748t	Angiogenesis, 305
for seasonal conjunctivitis, 561	of cornea, 704t, 706-707, 706t, 707t	Angiography, fluorescein. See
Allergic drug reaction, 703	of lens, 704t	Fluorescein angiography
to acetazolamide, 162	of optic nerve, 738	Angioscopy, fluorescein, 288
to anesthetic, 324-325	Amitriptyline, antimuscarinic dosage	Angiotensin-converting enzyme
to antihistamine, 253	of, 721t	inhibitor
to apraclonidine, 155	Amoxicillin	in sarcoidosis, 632
to atropine, 129	for conjunctivitis, 447	in uveitis, 597
brimonidine and, 157	inclusion, 457	Angle-closure glaucoma, 693-694
canaliculitis and, 433	for dacryoadenitis, 424	acetazolamide and, 160-161
to cephalosporin, 183	spectrum of activity of, 180t	after pupil dilation, 339
to local anesthetic, 94	Amoxicillin-clavulanate	atropine and, 129
loteprednol etabonate for, 228	in preseptal cellulitis, 391	cycloplegic refraction and, 344
to opioid, 107	spectrum of activity of, 181-182	decongestants contraindicated
to penicillin, 182-183	Amphetamine, 718	in, 249
to polymyxin B, 187	Amphotericin B, 205, 208, 213t	pilocarpine contraindicated in, 170
to sulfonamides, 193	in fungal keratitis, 536	pilocarpine for, 168
to verteporfin, 304	indications for and side effects of, 211t	pupil dilation in, 335-337

		Index	763
Angle-closure glaucoma—cont’d	Antiallergy drug—cont’d	Antibody—cont’d
risk of pupil dilation and, 67	cell-mediated immune response	monoclonal, 306-308
tropicamide and, 137	and, 247	in myasthenia gravis, 372
Angular blepharitis, 385, 385f	decongestants as, 247, 248t, 249	Anticholinergic agent
Anhidrosis, 354	hypersensitivity response and, 245-	adverse effects of
Anidulafungin, 208, 215	247, 246t, 247t	on intraocular pressure, 720, 720b,
Animal model, of surface inflammation,	mast cell stabilizers as, 255, 256t, 257	721t
240	mast cell-antihistamine combinations	on pupil, 718, 718b
Anisocoria, 349-351	as, 257, 258t, 259	myopia caused by, 721-722
differential diagnosis of, 351t	nonsteroidal anti-inflammatory drugs	unilateral fixed and dilated pupil and,
disorders characterized by, 350b	as, 259	361-362, 361f, 362f
in light versus dark, 349-350, 351f	steroids as, 259	Anticholinesterase
overview of, 349	Antiangiogenesis drug, 305-306	for accommodative esotropia, 665
pharmacologic evaluation of, 350-352,	for age-related macular degeneration,	adverse effects on pupil, 719
352t	638	in phthiriasis palpebrarum, 399
photographs of patient with, 350	Antibacterial drug, 177-196. See also	Anticoagulant in acute retinal necrosis,
physical findings with, 350	Antibiotic, prophylactic; Anti-	622
physiologic, 352	infective drug	Antidepressant for blepharospasm,
pupil size in, 349	affecting cell membrane, 186-187	377
slit-lamp examination of, 350	affecting cell wall synthesis, 179-186	Antiedema drug, 279-281, 280b, 280t,
Anisometropia, 665-666	bacitracin as, 185	282f
Antazoline, 254, 254t, 551t	cephalosporins as, 183-185	Antifungal drug, 204, 205, 209t-213t,
Antazoline-naphazoline, 255	penicillins as, 179-183. See also	213-215
Anterior angle, evaluation of, 330-333	Penicillin	azole, 208, 213-214
gonioscopy for, 332-333, 333f, 333t	vancomycin as, 185-186	echinocandin, 210t-212t
shadow test in, 330, 331f	affecting DNA synthesis, 194-196,	nonnucleoside reverse transcriptase
slit-lamp method for, 330, 331f,	194t	inhibitor, 206t
332f	affecting folate metabolism, 193-194	nucleoside reverse transcriptase
Anterior basement membrane	affecting protein synthesis, 187-193	inhibitor, 206t
dystrophy, 486-488, 487f	amikacin as, 190	polyene, 208, 209t-210t
in recurrent corneal erosion, 504,	aminoglycosides as, 187-190	Antigen
505, 506	chloramphenicol as, 192-193	in contact dermatitis, 570
Anterior chamber in uveitis, 590	gentamicin as, 188	in thyroid disease, 660
Anterior margin of eyelid, 381-386	macrolides as, 191-192	Antiglaucoma agent
blepharitis in, 381-382	neomycin as, 187-188	complications of, 77
distribution system disorder and, 425	tetracyclines as, 190-191, 190t	conjunctiva damaged by, 8
hygiene of, 384b	tobramycin as, 189	drug interactions with, 6t
infection of, 382-384, 383f	bacteria causing infections and, 177,	Antihelmintic agent
seborrheic blepharitis of, 385-386,	178b	for phthiriasis palpebrarum, 399
385f, 386f	bacterial structure and, 179	in toxocariasis, 630
Anterior scleritis, diffuse, 580, 580f	for blepharitis, 384	Antihistamine, 249-250, 251t-252t,
Anterior segment in sarcoidosis, 632	for conjunctivitis, 442t, 446-449	253-255, 558t-559t
Anterior segment ocular coherence	failure of, 177b	adverse effects of
tomography, 675	for initial treatment, 176t	on pupil, 719
Anterior stroma	resistance to, 177-179	reduced tear production, 714
foreign body and, 502	Antibiotic, prophylactic. See also	for blepharospasm, 377
puncture of, 506	Antibacterial drug; Anti-infective	contraindications to, 253-254, 255
in recurrent corneal erosion, 507	agent	examples of, 551t-553t
Anterior subcapsular cataract, 708-709,	in bullous keratopathy, 494	in seasonal conjunctivitis, 560
708t, 709f	for cataract surgery, 601	side effects of, 253, 255
Anterior uveitis	for contact lens-related	for urticaria, 572
complications of, 596	complications, 540	Antihypertensive agent, lacrimation
description of, 587	for corneal abrasion, 497	and, 715
diagnosis of, 590-591, 591t	dellen and, 512-513	Anti-immune activity in epidemic
in interstitial keratitis, 516	for phlyctenular keratoconjunctivitis,	keratoconjunctivitis, 527
latanoprost and, 143	518	Anti-infective agent, 175-220
loteprednol etabonate for, 228	in recurrent corneal erosion, 505	adenoviral conjunctivitis and, 454
metipranolol and, 152	Antibiotic-associated	antibacterial, 177-196. See also
Anthralin, for psoriasis, 465	pseudomembranous colitis, 184	Antibacterial drug
Antiallergy drug, 245-261	Antibiotic-steroid combination, 601, 602	antifungal, 204-215. See also
antihistamines as, 249-250, 251t-252t,	Antibody	Antifungal drug
253-255	antinuclear, 597	antiprotozoan, 215, 216t, 217

764	Index
Anti-infective agent—cont’d		Antiviral agent—cont’d	Aspirin—cont’d
antiviral, 196-205. See also Antiviral		overview of, 196-197	side effects of, 99-100
	agent	for progressive outer retinal necrosis,	in vernal keratoconjunctivitis, 566
for conjunctivitis, principles of, 444		625	Asthma
guidelines for using, 175-177, 176b,		valacyclovir	aspirin and, 100
	177t	clinical indications for, 202t	levobunolol and, 151
Anti-inflammatory agent		clinical uses of, 201, 202t-203t, 204	opioid and, 107-108
in epidemic keratoconjunctivitis, 527		guidelines for, 199t	pilocarpine contraindicated in, 170
for toxoplasmosis, 628		pharmacology of, 201	Astigmatism control, suture for, 603-604
Anti-inflammatory drug, 221-244		Aplastic anemia	Atazanavir, 207t
corticosteroids as, 221-233. See also		chloramphenicol-induced, 192-193	Atopic dermatitis. See also Allergic eye
	Corticosteroid	methazolamide and, 164	disease
nonsteroidal, 97-109, 233-235. See also		sulfonamides causing, 193-194	conjunctivitis and, 466-467, 466f
	Nonsteroidal anti-inflammatory	Applanation tonometry, 671-674, 673b.	of eyelid, 568, 569t, 570
	drug	See Tonometry	Atovaquone
pharmacology of, 233-235, 234f		Approved Drug Products with	adverse effects of, 754t
for tear stimulation, 275		therapeutic Equivalency	for toxoplasmosis, 628
Antimetabolite, for uveitis, 595		Evaluations, 58-59	Atresia of lacrimal puncta, 432
Antimicrobial agent. See Anti-infective		Apraclonidine, 154-155, 690, 690t	Atrophy, peripapillary, 678, 678f
	agent	in anisocoria evaluation, 352t	Atropine
Antimuscarinic agent, reduced tear		formulations of, 154t	administration, 346
	production with, 714	Aptivus, 207t	for amblyopia, 664-665, 665b
Antimuscarinic effect, drugs causing,		Aqueous deficiency, 264. See also Dry eye	anticholinergic mydriasis caused by,
	720, 721t	Aqueous flow, fluorescein and, 288	361-362
Antineoplastic agent, drugs adversely		Aqueous humor	antimuscarinic dosage of, 721t
	affecting, retinal, 731-733, 732f,	acetazolamide and, 160	characteristics of, 345t
	733b	betaxolol and, 151	clinical uses of, 128
Antinuclear antibody, in uveitis, 597		dexamethasone and, 227-228	contraindications to, 129
Antioxidant, 31b		structure of, 23	for corneal ulcers, 524
Antioxidant vitamin, 295. See also		Aqueous layer of tear film, 17, 263-264,	in neovascular glaucoma, 693
	Vitamin A, Vitamin C, Vitamin E	264f, 416	pharmacology of, 126, 127t, 128
Antiparkinson agent, for blepharospasm,		Aqueous suppressant, 689-691, 689b,	preparations of, 127t
	377	689t	side effects of, 129
Antiprotozoan drug, 215, 216t, 217		Aralen, 750t	Atropine mydriasis, 361
Antipseudomonal drug, penicillin for, 182		ARED study, 299, 300	Atropine penalization, 664-665, 665b
Antithyroid drug, 652-653		Aredia, 752t	Autoimmune disorder
Antiviral agent, 196-205		Arlt’s line, 458, 458f	myasthenia gravis as, 372-376, 373f,
acyclovir		Arthritis, 472-473	375f
for acute retinal necrosis, 621-622		Arthropathy, fluoroquinolones and, 195	scleritis in, 580
clinical indications for, 202t		Artificial tears, 266-272, 426	systemic lupus erythematosus as
for herpes simplex infection, 197,		autologous serum as, 272	conjunctiva in, 459, 460t, 472-474,
	198t-199t, 202t	buffers in, 269-270	473f
for herpes simplex keratitis, 530		characteristics of, 266	drug-induced, 740, 740b, 741b
for herpes zoster ophthalmicus,		dellen and, 512	uveitis with, 588b
	396, 532	electrolytes in, 269	Autologous serum
for progressive outer retinal		inserts for, 271-272, 272f	as artificial tears, 272
	necrosis, 625	mucolytic agents in, 271	in recurrent corneal erosion, 506
for adenoviral conjunctivitis, 454		nutrients in, 270-271	Auxiliary information on prescriptions,
clinical indications for, 202t		polysaccharides as, 266-268	56b
for epidemic keratoconjunctivitis, 527		preservatives in, 270	Avastin, 307
famciclovir		for Thygeson’s superficial punctate	Avellino dystrophy, 485t
clinical indications for, 203t		keratitis, 533-534	Avitaminosis A, 478
guidelines for, 199t		Ascorbate in burn injury, 511	Azathioprine
for herpes zoster conjunctivitis, 456		Aspergillus, 205, 534	in myasthenia gravis, 375, 376
for herpes zoster ophthalmicus, 532		flucytosine for, 208	for ocular cicatricial pemphigoid, 468
pharmacology and, 204		Aspirin, 99t	in systemic lupus erythematosus, 471
for herpes simplex infection, 197,		adverse effects of, 751t	for uveitis, 595
	198t-199t, 202t, 530	for allergic disease, 554t	Azelastine, 258t, 553t
for herpes zoster conjunctivitis, 456		clinical uses of, 99	in seasonal conjunctivitis, 561
for herpes zoster ophthalmicus,		common formulations of, 99t	Azithromycin
	396, 532	contraindications to, 100	for conjunctivitis, 447
intravitreal administration of, 50-51		pharmacology of, 98	for internal hordeolum, 390

		Index	765
Azithromycin—cont’d	Benadryl, 251t, 551t	Bion Tears, 267t, 427t
in preseptal cellulitis, 391	Benign essential blepharospasm, 376-	Bird-shot retinochoroiditis, 241
for toxoplasmosis, 628	379, 376f, 378t	Bis-biguanide, 215
for trachoma, 458	Benign eyelid twitching, 407-408	Bisphosphonate, 716, 716t
Azole antifungal drug, 208, 209t-210t,	Benign tumor of eyelid, 399-402	Blepharitis, 381-382
213-214	sebaceous cysts as, 401-402, 401f	angular, 385, 385f
ketoconazole as, 208, 213	sudoriferous cysts as, 401, 401f	antibacterial drugs for, 176t
Azotemia, tetracyclines causing, 190	verrucae as, 399-401, 400f	in atopic dermatitis, 568
B	xanthoma palpebrarum as, 402, 402f	in atopic keratoconjunctivitis, 567
B	Benoxinate, 89	cyclosporine A for, 242
Bacitracin, 185	Benoxinate-sodium fluorescein, 320	dry eye and, 425
for blepharitis, 384	Bentropine, 721	phlyctenular keratoconjunctivitis and,
for conjunctivitis, 448	Benzalkonium chloride	518
formulations of, 186t, 187t	effects of, 30	in rosacea, 388-389, 388f
pathogens susceptible to, 442t	toxic conjunctivitis and, 474	seborrheic, 385-386, 385f, 386f
in phlyctenulosis, 475	Benzodiazepine, 377	dry eye and, 425
steroids with, 188t	Beta zone, 678, 678f	trimethoprim-polymyxin B for, 193
Bacitracin-polymyxin B	Beta-blocker	Blepharoconjunctivitis
for chronic conjunctivitis, 451	adverse effects of	decongestants causing, 249
in thyroid disease, 653	on intraocular pressure, 720-721	herpes simplex, 393, 393f
Baclofen, 377	reduced tear production, 714	Blepharospasm, benign essential, 376-
Bacteria	in angle-closure glaucoma, 693	379, 376f, 378t
morphology of, 179f	betaxolol as, 151-152	Blindness, special considerations in,
structure of, 179	for blepharospasm, 377	13-14, 13f-14f
Bacterial blepharitis, 382-383	brimonidine and, 156	Blink, incomplete, 406
Bacterial conjunctivitis, 446-449, 449f	carteolol as, 152-153, 153f	Blinking, 417
acute, 444-449, 445f, 446f	choice of, 153, 153t	Block
diagnosis of, 445-446	complications of, 77	nerve, 323-324, 324f
etiology of, 444-445	levobunolol as, 150-151	retrotarsal, 327f
management of, 446-449, 449f	metipranolol as, 152	Blood agar, 441
chronic, 451	systemic effects of, 9t	Blood count in uveitis, 597
hyperacute, 449-451, 450f	timolol as, 145-150, 146t, 148b, 149f	Blood disorder
Bacterial dacryoadenitis, 424	Beta-carotene, 636	chloramphenicol causing, 192-193
Bacterial infection with scleritis, 577b	Betagan, 146t	penicillin and, 182
Bacterial keratitis, 514-525. See also	Beta-lactamase	sickle cell
Keratitis, bacterial	cephalosporin and, 183	acetazolamide and, 163
corneal infiltrative events versus, 519t	penicillin and, 181	intraocular pressure and, 692-693
fluoroquinolones for, 195	Betamethasone, 231	Blood dyscrasias
infiltrative events in, 519-520, 519f,	Betaxolol, 151-152	acetazolamide causing, 162
519t	formulations of, 146t	sulfonamides causing, 193-194
interstitial, 515-517, 516b, 516t	for glaucoma, 689t	Blood pressure, phenylephrine and,
phlyctenular keratoconjunctivitis,	Betimol, 146t	116-117
517-518, 518f	Bevacizumab, 307, 308, 639	Blood supply, drug removal by, 25
superficial punctate, 514-515, 514f	Bextra, 751t	Blood vessel, retinal, 618-619, 618f
ulcers and, 520-525, 521f, 521t, 522f	Biguanide, 215	Blood-brain barrier, 250
Bacteroides in preseptal cellulitis, 391	Bimatoprost, 144-145, 687-688, 687t	Blurred vision after pupil dilation, 339
BAK, 269	Binding of drug, 702	Bone, tetracyclines affecting, 190
Band keratopathy, 596	Binocularity, testing of, 7	Bone marrow depression, 192
Bandage soft contact lens in thyroid	Bioavailability, 27-36	Bonefos, 753t
disease, 653	active ingredients and, 28	Borrelia burgdorferi, 459
Barrier	drug release systems and, 34, 35t, 36	Botulinum toxin, 666-669, 667b
compartment theory and, 25-26	osmolarity and, 28	adverse effects of, 668-669
conjunctival, 444	preservatives and, 28, 30-31	for blepharospasm, 377-379, 378f, 378t
retinal, 24-25	stability and, 28	clinical uses of, 666-668
Basal cell carcinoma, 403-404, 403f, 404f	vehicles and, 31-34, 31b, 32t, 33f	pharmacology of, 668
Basal layer of tears, 17	Bioequivalency, 58-59	in thyroid-related orbitopathy, 654-655
Basement membrane dystrophy,	Biomicroscopy	Bowman’s layer
anterior, 486-488, 487f	in anterior basement dystrophy, 486	anatomy of, 483
Basic Schirmer test, 420-421	in anterior uveitis, 590	dystrophy of, 484t
Basophil, 550	in intermediate uveitis, 592	hydrops and, 491f
BC Powder, 104t	in posterior uveitis, 592-593	Bowman’s membrane, foreign body
Behçet’s disease, 241	of tear film, 420	and, 502

766	Index
Brain injury, cycloplegic refraction in, 343		Carbachol, 688-689, 688t	Cataract surgery—cont’d
Branch retinal vein occlusion, 632, 634		Carbenicillin, 180t	cystoid macular edema as, 613-614,
Brand-name drug, 58-59		Carbonic anhydrase inhibitor, 158-167	614f
Breach of standard of care, 71		acetazolamide as	endophthalmos as, 604, 606-607,
Breakup time, tear, 421-422		clinical uses of, 160-161	606f
Breast feeding		contraindications to, 162-163, 162b	of eyelids and conjunctiva, 604
homatropine and, 130		pharmacology of, 159-160, 161t	hyphema as, 610-611, 610f, 611f
opioid and, 107		side effects of, 161-162, 162b	intraocular lens dislocation as,
precautions for, 9-11		adverse effects of, 755t	612-613, 613f
verteporfin and, 304		brimonidine and, 156	ocular hypertension as, 608
Brimonidine, 155-158, 156f, 157f, 158f,		complications of, 77	ocular hypotony as, 607, 607f
	690, 690t	for glaucoma, 691, 691t	posterior capsular opacification as,
clinical uses of, 157		mechanism of action of, 158-159, 160f	611-612, 612f
contraindications to, 157-158		methazolamide as, 163-164	pupil distortion as, 609-610, 610f
indomethacin and, 235		myopia caused by, 720	retinal detachment as, 614-615, 614f
pharmacology of, 155-157		topical, 164-167	cystoid macular edema after, 633
side effects of, 157		brinzolamide as, 165-166, 166f	infection prevention in, 601
systemic effects of, 9t		combination agent, 166-167	inflammation control after, 602
Brinzolamide, 165-166, 166f		Carboxymethylcellulose, 32, 266-267,	intraocular pressure and, 603
Bromfenac		267t	latanoprost and, 143
clinical uses of, 236		Carcinoma	optimizing vision after, 603-604, 604f
in episcleritis, 578		basal cell, 403-404, 403f, 404f	pain management after, 603
formulations of, 236t		sebaceous gland, 404, 404f	patient education about, 601
Bromhexine, 274		Cardiac glycoside	postoperative management of, 605t
Bromocriptine, 377		adverse effects of, 723	pupil dilation after, 337-338, 338f
Brompheniramine, 251t		retinal effects of, 729, 729b, 730f	toxoplasmosis and, 628
Broth, thioglycolate, 441		Cardiovascular disease,	Cautery, 409
Bruch’s membrane, 635		contraindications related to, 5	CD4 lymphocyte, in AIDS, 204
Buffer, 31b		Cardiovascular effect	Ceclor, 184t
in artificial tears, 269-270		of carteolol, 153	Cefaclor
Bulbar conjunctiva, 437-438, 438f		hydroxyamphetamine and, 119	for conjunctivitis, 447
Bulla in herpes simplex keratitis, 528		phenylephrine and, 117	indications for, 183, 184t, 185
Bullous keratopathy, 493-494, 493f		Cardiovascular status, testing of, 7	side effects of, 185
Bupivacaine, injectable, 87t		Cardiovascular system	Cefazolin
Burn		apraclonidine and, 155	for corneal ulcer, 523
chemical, 479		beta-blockers affecting, 148b, 149	indications for, 183, 184t
corneal, 509-511, 510f, 510t		betaxolol and, 151-152	Cefepime, 184t
C		brimonidine and, 158	Cefotan, 184t
C		dorzolamide and, 164	Cefotaxime, 447
Calcific band keratopathy, 494-496, 495f		Carmustine, 732-733, 733b, 753t	Cefotetan, 183, 184t
Calcineurin inhibitor, 570		reduced tear production, 715	Cefoxitin, 183, 184t
Calcium channel, 151		Carteolol, 152-153, 153f	Cefprozil, 183, 184t
Calcium deposit, corticosteroid-induced,		formulations of, 146t	Ceftriaxone, 183, 184t
	232	for glaucoma, 689t	Ceftazidime, 183, 184t
Calcium-phosphorus ratio, 494		CARVES mnemonic, 677	Ceftin, 184t
Calculus, renal, 163		Caspofungin, 208, 210t, 212t, 213t, 214	Ceftriaxone, 461
Canadian form for reporting drug		Cataract. See also Cataract surgery	Cefuroxime
	reaction, 744f-745f	anterior subcapsular, 708-709, 708t,	for conjunctivitis, 447
Canalicular disorder, 433		709f	indications for, 183, 184t
Cancidas, 210t		in atopic dermatitis, 568	Cefzil, 184t
Candida, 205		in atopic keratoconjunctivitis, 567	Celebrex, 102t, 751t
amphotericin B for, 208		comanagement of, 64b	Celecoxib, 751t
keratitis and, 534		corticosteroid induced, 229-230, 229f	formulation of, 102t
Cannabinoid, 758t		nutritional supplements for, 298t, 299	Cell
intraocular pressure and, 725		pilocarpine contraindicated in, 170	in anterior uveitis, 590, 591b
Cannula, lacrimal, 430, 431f		posterior subcapsular	bacterial versus human, 179
Canthaxanine, 758t		steroid-induced, 705	CD4 lymphocyte, 204
Canthaxanthin, 741		uveitis and, 596	goblet, 437-438
Capillary, retinal, 24		Cataract surgery, 601-615. See also	inflammatory, 439
Capsular opacification, posterior,		Cataract	Langerhans, 438
	611-612, 612f	complications of, 604, 606-615	mast, 246f
Capsulotomy, endophthalmos and, 606		corneal edema as, 608-609, 609f	xanthoma, 402, 402f

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