3. Visual hallucinations

4. Eyelids or conjunctivitis

a.Allergic reactions

b.Erythema

c.Conjunctivitis – non-specific

d.Urticaria

e.Purpura

f.Pemphigoid lesion

g.Keratoconjunctivitis sicca

5. Non-specific ocular irritation

a.Lacrimation

b.Photophobia

c.Ocular pain

Probable

1. Decreased intraocular pressure

2. Decreased lacrimation

3. Myasthenia gravis

a.Diplopia

b.Ptosis

c.Paresis of extraocular muscles

Possible

1. Decreased accommodation

2. Exophthalmos – withdrawal states

3. Eyelids or conjunciva

a.Lupoid syndrome

b.Erythema multiforme

c.Stevens-Johnson syndrome

d.Exfoliative dermatitis

Conditional/Unclassified

1. Intracranial hypertension

Local ophthalmic use or exposure

Certain

1. Local anesthetic effect (propranolol)

2. Irritation

a.Hyperemia

b.Ocular pain

c.Burning sensation

3. Decreased intraocular pressure

4. Miosis

Clinical significance

Adverse ocular side effects due to these agents are usually ­insignificant and transient. Dennis et al (1991) reviewed a series of patients with side effects from oral beta blockers. The visual side effect ‘changes in vision’ was the fifth most common of all systemic complaints. As with all beta-adrenergic blocking agents, one needs to be aware of the possibility of sicca-like syndrome. There are many cases in the literature and in the National Registry to implicate these drugs in causing a kerato­ conjunctivitis sicca-like syndrome, probably on the basis of decreased lacrimation. This often appears as a sudden onset of ocular sicca with conjunctival hyperemia shortly after starting the drug. In the National Registry’s experience, one of the most bothersome side effects is transient diplopia with an unknown cause. This may resolve even if these drugs are continued. Yeomans et al (1983) described a case where propanolol may have caused an inflammatory lymphoid process of the iris and ciliary body, which resolved without treatment when propranolol was discontinued. While propranol is structurally similar to practolol, to date there has been no oculocutaneous

syndrome associated with this agent. Topical ocular use of these agents has little clinical application, although it has been advocated for thyrotoxic lid retraction and glaucoma therapy. Propranolol given topically on the eye has a local anesthetic effect.

References And Further Reading

Almog Y, et al. The effect of oral treatment with beta blockers on the tear secretion. Metab Pediatr Syst Ophthalmol 6: 343, 1982.

Dennis KE, Froman D, Morrison AS, et al. Beta blocker therapy: identification and management of side effects. Heart & Lung 20(5 Pt 1): 459–463, 1991.

Dollery CT, et al. Eye symptoms in patients taking propranolol and other hypotensive agents. Br J Clin Pharmacol 4: 295, 1977.

Draeger J, Winter R. Corneal sensitivity and intraocular pressure. In: ­Glaucoma Update II, Krieglstein GK, Leydhecker W (eds), SpringerVerlag, New York, pp 63–67, 1983.

Felminger R. Visual hallucinations and illusions with propranolol. BMJ 1: 1182, 1978.

Holt PJA, Waddington E. Oculocutaneous reaction to oxprenolol. BMJ 2: 539, 1975.

Kaeser HE. Drug-induced myasthenic syndromes. Acta Neurol Scand 70(suppl. 100): 39, 1984.

Knapp MS, Galloway NR. Ocular reactions to beta blockers. BMJ 2: 557, 1975.

Lewis BS, Setzen M, Kokoris N. Ocular reaction to oxprenolol. A case report. S Afr Med J 50: 482, 1976.

Malm L. Propranolol as cause of watery nasal secretion. Lancet 1: 1006, 1981. Ohrstrom A, Pandolli M. Regulation of intraocular pressure and pupil size by β-blockers and epinephrine. Arch Ophthalmol 98: 2182, 1980. Pecori-Giraldi J, et al. Topical propranolol in glaucoma therapy and investi-

gations on the mechanism of action. Glaucoma 6: 31, 1984. Singer L, Knobel B, Itomem M. Influence of systemic administered beta

blockers on tear secretion. Ann Ophthalmol 16: 728, 1984. Weber JCP. Beta-adrenoreceptor anatagonists and diplopia. Lancet 2:

826–827, 1982.

Yeomans SM, et al. Ocular inflammatory pseudotumor associated with propranolol therapy. Ophthalmology 90: 1422, 1983.

Generic name: Quinidine.

Proprietary names: Generic only.

Primary use

This isomer of quinine is effective in the treatment and prevention of atrial, nodal and ventricular arrhythmias.

Ocular side effects

Systemic administration

Certain

1. Decreased vision

Probable

1. Problems with color vision – color vision defect, red-green defect

2. Eyelids or conjunctiva

a.Allergic reactions

b.Hyperpigmentation

c.Photosensitivity

d.Angioneurotic edema

e.Urticaria

3. Anterior granulomatous uveitis

4. Visual hallucinations

agents renal and vascular Cardiac, • 6Stionec