Klein BEK, Klein R, Jensen SC, Linton KLP. Hypertension and lens opacities from the Beaver Dam eye study. Am J Ophthalmol 119: 640–646, 1995.

Krieg PH, Schipper I. Drug-induced ciliary body oedema: a new theory. Eye 10(pt 1): 121–126, 1996.

Miller NR, Moses H. Transient oculomotor nerve palsy. Association with thiazide-induced glucose intolerance. JAMA 240: 1887, 1979.

Palmer FJ. Incidence of chlorthalidone-induced hypercalcemia. JAMA 239: 2449, 1978.

Robinson HN, Morison WL, Hood AF. Thiazide diuretic therapy and chronic photosensitivity. Arch Dermatol 121: 522, 1985.

Söylev MF, Green RL, Feldon SE. Choroidal effusion as a mechanism for transient myopia induced by hydrochlorothiazide and triamterene. Am J Ophthalmol 120(3): 395–397, 1995.

Sponsel WE, Rapoza PA. Posterior subcapsular cataract associated with indapamide therapy. Arch Ophthalmol 110: 454, 1992.

Generic name: Furosemide.

Proprietary name: Lasix.

Primary use

This potent sulfonamide diuretic is effective primarily in the treatment of hypertension complicated by congestive heart failure or renal impairment.

Ocular side effects

Systemic administration

Certain

1. Decreased vision

2. Problems with color vision – objects have yellow tinge 3. Eyelids or conjunctiva

a.Allergic reactions

b.Photosensitivity

c.Urticaria

d.Purpura

h. Pemphigoid lesion 4. Visual hallucinations

Probable

1. Decreased intraocular pressure – minimal

2. Decreased tolerance to contact lenses

Possible

1. Eyelids or conjunctiva

a.Lupoid syndrome

b.Erythema multiforme

c.Exfoliative dermatitis

2. Subconjunctival or retinal hemorrhages secondary to druginduced anemia

Ocular teratologic effects

Conditional/Unclassified

1. Blindness

Clinical significance

Furosemide has potent systemic side effects and is not commonly used. Ocular side effects are rare and seldom of significance. One instance of a baby born blind after the mother took 40 mg of furosemide three times daily during her second trimester has been reported. Lee et al (2004) found little clinical or pharmacologic evidence of sulfa allergy causing life-threatening crossreaction with furosemide.

References And Further Reading

Castel T, et al. Bullous pemphigoid induced by furosemide. Clin Exp Dermatol­ 6: 635, 1981.

Davidson SI. Reports of ocular adverse reactions. Trans Ophthalmol Soc UK 93: 495, 1973.

Lee AG, Anderson R, Kardon RH, et al. Presumed ‘sulfa allergy’ in patients with intracranial hypertension treated with acetazolamide or furosemide: cross-reactivity, myth or reality? Am J Ophthalmol 138: 114–118, 2004.

Peczon JD, Grant WM. Diuretic drugs in glaucoma. Am J Ophthalmol 66: 680, 1968.

Zugerman C, La Voo EJ. Erythema multiforme caused by oral furosemide. Arch Dermatol 116: 518, 1980.

Class: Osmotics

Generic name: Glycerol (glycerin).

Proprietary names: Colace infant/child, Computer eye drops, Eye lube-A, Fleet bablax, Osmoglyn, Sani-Supp.

Primary use

Systemic

This trihydric alcohol is a hyperosmotic agent used to decrease intraocular pressure in various acute glaucomas and in preoperative intraocular procedures.

Ophthalmic

This topical trihydric alcohol is a hyperosmotic used to reduce corneal edema for diagnostic procedures, increased comfort or improved vision.

Ocular side effects

Systemic administration

Certain

1. Decreased intraocular pressure

2. Subconjunctival or retinal hemorrhages

3. Visual hallucinations

4. Decreased vision

Possible

1. Retinal tears

2. Expulsive hemorrhage

Local ophthalmic use or exposure

Certain

1. Irritation

a.Lacrimation

b.Hyperemia

c.Ocular pain

d.Burning sensation 2. Vasodilation

3. Subconjunctival hemorrhages

Possible

1. Corneal endothelial damage

2. Contact allergy

Clinical significance

Systemic glycerin causes decreased intraocular pressure, which is an intended ocular response, and has surprisingly few other ocular effects. However, severe vitreal dehydration with resultant shrinkage of the vitreous may possibly cause traction on the adjacent retina,

agents renal and vascular Cardiac, • 6Stionec