effects side ocular induced-Drug •   PART7  

4. Eyelids or conjunctiva

a.Allergic reactions

b.Hyperemia

c.Angioneurotic edema

d.Urticaria

5. Visual hallucinations

Possible

1. Keratoconjunctivitis sicca

2. Subconjunctival or retinal hemorrhages secondary to drug-induced anemia

3. Eyelids of conjunctiva

a.Erythema multiforme

b.Stevens-Johnson syndrome

c.Exfoliative dermatitis

d.Lyell’s syndrome

Clinical significance

While thiabendazole is a potent therapeutic agent, it has surprisingly few reported ocular or systemic toxic side effects. Ocular side effects that occur are transitory, reversible, and seldom of clinical importance. However, a mother and daughter after only a few doses developed keratoconjunctivitis sicca, xerostomia, cholangiostatic hepatitis and pancreatic dysfunction. Rex et al (1983) and Davidson et al (1988) reported a case similar to this. Some feel these reactions may represent an allergic response to the dead parasites rather than a direct drug effect. This agent may induce ocular pemphigoid-like syndrome.

References and Further Reading

Drugs for parasitic infections. Med Lett Drugs Ther 24: 12, 1982. Davidson RN, Weir WRC, Kaye GL, McIntyre N. Intrahepatic

cholestasis after thiabendazole. Trans R Soc Trop Med Hyg 82: 620, 1988.

Fink AI, MacKay CJ, Cutler SS. Sicca complex and cholestatic jaundice in two members of a family caused by thiabendazole. Trans Am Ophthalmol Soc 76: 108, 1978.

Fraunfelder FT. Interim report: national registry of drug-induced ocular side effects. Ophthalmology 86: 126, 1979.

Fraunfelder FT, Meyer SM. Ocular toxicology update. Aust J Ophthalmol 12: 391–394, 1984.

Rex D, Lumeng L, Eble J, et al. Intrahepatic cholestasis and sicca complex after thiabendazole. Gastroenterology 85: 718–721, 1983.

Robinson HJ, Stoerk HC, Graessle O. Studies on the toxicologic and pharmacologic properties of thiabendazole. Toxicol Appl Pharmacol 7: 53–63, 1965.

Class: Antibiotics

Generic name: Amikacin.

Proprietary name: Amikin.

Primary use

This systemically administered aminoglycoside is primarily used for Gram-negative infections.

Ocular side effects

Systemic administration

Certain

1. Decreased vision

2. Eyelids or conjunctiva

a.Urticaria

b.Purpura

Fig. 7.1a  Amikacan retinal toxicity: diffuse arteriolar occlusion as seen on fluroescein angiography. Photo courtesy of the British Journal of Ophthalmology.

Local ophthalmic use or exposure – intravitreal injection­

Certain

1. Macular infarcts

2. Retinal toxicity (Fig. 7.1a)

3. Retinal degneration

Clinical significance

This aminoglycoside rarely causes ocular side effects when given orally. Ophthalmologists’ interest in this antibiotic is primarily for intravitreal injections, usually in combination with a cephalosporin for management of endophthalmitis. Gentamicin has been the aminoglycoside of choice for intravitreal injections until reports of macular infarcts occurred. Amikacin was shown to be less toxic to the retina than gentamicin, so many surgeons started using it intravitreally. However, now cases of retinal infarcts have been reported with this agent, with perifoveal capillaries becoming occluded, as per fluorescein angiography. Recently, D’Amico et al (1985) found lysomal inclusions in the retinal pigment epithelium secondary to amikacin. Campochiaro (Campochiaro and Conway 1991; Campochiaro and Green 1992; Campochiaro and Lim 1994) pointed out the role of the dependent position of the macula at the time of intravitreal injection with the resultant potential increased concentration of this drug over the macula. Aminoglycosides have a known toxic effect on ganglion and other neural cells of the retina. Doft and Barza (1994, 2004), from the Endophthalmitis Vitreous Study Group, feel that the data are not compelling enough to suggest a different antibiotic, and still continue to recommend amikacin as the empirical standard to date. The National Registry is aware of more than 30 cases of macular infarct associated with amikacin use. However, based on risk/benefit ratios, along with the available clinical data, Doft and Barza’s recommendation seems reasonable. This is, however, an area of controversy among retinal specialists shown by Galloway et al (2002, 2004).

References and Further Reading

Campochiaro PA, Conway BP. Aminoglycoside toxicity – A survey of retinal specialists: implications for ocular use. Arch Ophthalmol 109: 946–950, 1991.

Campochiaro PA, Green WR. Toxicity of intravitreous ceftazidime in ­primate retina. Arch Ophthalmol 110: 1625–1629, 1992.