effects side ocular induced-Drug  • PART7  

2. Eyelids or conjunctiva

a.Allergic reactions

b.Hyperemia

c.Photosensitivity

d.Angioedema

e.Urticaria

3. Visual hallucinations (clarithromycin)

Probable

1. Myasthenia gravis – aggravates (erythromycin)

a.Diplopia

b.Ptosis

c.Paresis of extraocular muscles

Possible

1. Cornea – subepithelial deposits (clarithromycin)

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

3. Eyelids or conjunctiva

a.Stevens-Johnson sydrome

b.Exfoliative dermatitis

c.Lyell’s syndrome (erythromycin)

Local ophthalmic use or exposure – topical application or subconjunctival injection

Certain

1. Irritation

a.Hyperemia

b.Ocular pain

c.Edema

2. Eyelids or conjunctiva

a.Allergic reactions

b.Angioedema

3. Overgrowth of non-susceptible organisms

Possible

1. Mydriasis (erythromycin)

2. Corneas – subepithelial deposits (clarithromycin)

3. Eyelids of conjuncticva – Stevens-Johnson syndrome (erythromycin)

Local ophthalmic use or exposure – intracameral injection­

Certain

1. Uveitis (erythromycin)

2. Corneal edema (erythromycin)

3. Lens damage (erythromycin)

Local ophthalmic use or exposure – retrobulbar or subtenon injection

Possible

1. Irritation (clindamycin)

2. Optic neuritis (clindamycin)

3. Optic atrophy (clindamycin)

4. Diplopia (clindamycin)

Clinical significance

Few adverse ocular reactions due to either systemic or topical ocular use of these antibiotics are seen. Nearly all ocular side effects are transitory and reversible after the drug is discontinued. Most adverse ocular reactions are secondary to dermatologic or hematologic conditions. A well-documented rechallenged ­idiosyncratic response to topical ocular application of erythro­ mycin causing mydriasis has been reported to the National

Registry. An interaction of erythromycin with carbamazepine causing mydriasis and gaze evoked nystagmus has been reported. The National Registry has also received a case of StevensJohnson syndrome following topical ophthalmic erythromycin ointment. Clarithromycin, with both oral and topical ocular exposure, has been associated with subepithelial infiltrate when treating mycobacterium avium complex. When the drug was stopped the deposits were absorbed. Visual hallucinations due to clarithromycin have only been seen when the drug was used in peritoneal dialysis.

References and Further Reading

Birch J, et al. Acquired color vision defects. In: Congenital and Acquired Color Vision Defects, Pokorny J, et al (eds), Grune & Stratton, New York, pp 243–350, 1979.

Dorrell L, Ellerton C, Cottrell DG, Snow MH. Toxicity of clarithromycin in the treatment of Mycobacterium avium complex infection

in a patient with AIDS. J Antimicrob Chemother 34: 605–606, 1994.

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

Lund Kofoed M, Oxholm A. Toxic epidermal necrolysis due to erythromycin. Contact Dermatitis 13: 273, 1985.

May EF, Calvert PC. Aggravation of myasthenia gravis by erythromycin. Ann Neurol 28: 577–579, 1990.

Oral erythromycins. Med Lett Drugs Ther 27: 1, 1985.

Tate GW Jr., Martin RG. Clindamycin in the treatment of human ocular toxoplasmosis. Canad J Ophthalmol 12: 188,

1977.

Tyagi AK, Kayarkar VV, McDonnell PJ. An unreported side effect of topical clarithromycin when used successfully to treat

Mycobacterium avium-intracellulare keratitis. Cornea 18: 606–607, 1999.

Zitelli BJ, et al. Erythromycin-induced drug interactions. An illustrative case and review of the literature. Clin Pediat 26: 117–119,

1987.

Generic name: Bacitracin.

Proprietary names: Ak-Tracin, Baci-IM.

Primary use

This polypeptide bactericidal agent is primarily effective against Gram-positive cocci, Neisseria and organisms causing gas gangrene.

Ocular side effects

Systemic administration

Certain

1. Decreased vision

2. Eyelids or conjunctiva

a.Allergic reactions

b.Angioneurotic edema

c.Urticaria

Probable

1. Myasthenia gravis (aggravates)

a.Diplopia

b.Ptosis

c.Paralysis of extraocular muscles