Possible

1. Optic neuritis

2. Myasthenia gravis (aggravates)

a.Diplopia

b.Ptosis

c.Paresis of extraocular muscles

3. Papilledema (intracranial hypertension)

4. Vivid light lavender-colored retinal vascular tree 5. Eyelids or conjunctiva

a.Lupoid syndrome

b.Erythema multiforme

c.Stevens-Johnson syndrome

d.Exfoliative dermatitis

e.Lyell’s syndrome

Local ophthalmic use or exposure – topical application

Certain

1. Irritation

2. Eyelids or conjunctiva

a.Allergic reactions

b.Conjunctivitis – follicular

c.Deposits

d.Photosensitivity

e.Hyperemia

3. Overgrowth of non-susceptible organisms

4. Delayed corneal wound healing

Possible

1. Eyelids or conjunctiva

a.Lupoid syndrome

b.Erythema multiforme

c.Stevens-Johnson syndrome

Conditional/Unclassified

1. Cornea – peripheral immune ring

Clinical significance

While there are numerous reported ocular side effects from systemic sulfa medication, most are rare and reversible. Probably the most common ocular side effect seen in patients on systemic therapy is myopia. This is transient, with or without induced astigmatism, usually bilateral and may exceed several diopters. This is most likely due to an increased anteriorposterior­ lens diameter secondary to ciliary body edema. In rare instances, this may decrease the depth of the anterior chamber or possibly cause a choroidal effusion, inducing angle-closure glaucoma (Waheep et al 2003). Tilden et al (1991) reported 12 cases of uveitis attributed to systemic use of sulfonamide derivatives. Most of the cases were bilateral occurring within 24 hours to as long as 8 days after first exposure to the sulfonamide. Three patients had a positive rechallenged with a recurrence of bilateral uveitis within 24 hours. Some of the patients had systemic findings of Stevens-Johnson syndrome, erythema multiforme, diffuse macular-vesicular rashes, stomatitis, glossitis and granulomatous hepatitis. Optic neuritis has been reported even in low oral dosages and is usually reversible with full recovery of vision (Lane and Routledge 1983).

The ophthalmologist should be aware that anaphylactic reactions, Stevens-Johnson syndrome and exfoliative dermatitis have all been reported, although rarely from topical ocular administration of sulfa preparations. Ocular irritation from crystalline sulfa in the tears may occur. Recently Gutt et al (1988) reported immune rings in the peripheral cornea, associated with topical ocular sulfamethoxazole.

References and Further Reading

Bovino JA, Marcus DF. The mechanism of transient myopia induced by sulfonamide therapy. Am J Ophthalmol 94: 99, 1982.

Chirls IA, Norris JW. Transient myopia associated with vaginal sulfanilamide suppositories. Am J Ophthalmol 98: 120, 1984.

Fajardo RV. Acute bilateral anterior uveitis caused by sulfa drugs. In Saari KM, Uveitis Update. Excerpta Medica, Amsterdam, 1984, p 115–118.

Flach AJ, Peterson JS, Mathias CGT. Photosensitivity to topically applied sulfisoxazole ointment. Evidence for a phototoxic reaction. Arch Ophthalmol 100: 1286, 1982.

Genvert GI, et al. Erythema multiforme after use of topical sulfacetamide. Am J Ophthalmol 99: 465, 1985.

Gutt L, Feder JM, Feder RS, et al. Corneal ring formation after exposure to sulfamethoxazole. Arch Ophthalmol 106: 726–727, 1988.

Hook SR, et al. Transient myopia induced by sulfonamides. Am J Ophthalmol 101: 495, 1986.

Lane RJM, Routledge PA. Drug-induced neurological disorders. Drugs 26: 124, 1983.

Mackie BS, Mackie LE. Systemic lupus erythematosus – Dermatomyositis induced by sulphacetamide eyedrops. Aust J Dermatol 20: 49, 1979.

Riley SA, Flagg PJ, Mandal BK. Contact lens staining due to sulphasalazine. Lancet 1: 972, 1986.

Tilden ME, Rosenbaum JT, Fraunfelder FT. Systemic sulfonamides as a cause of bilateral, anterior uveitis. Arch Ophthalmol 109: 67–69, 1991.

Vanheule BA, Carswell F. Sulphasalazine-induced systemic lupus erythematosus in a child. Eur J Pediatr 140: 66, 1983.

Waheep S, Feldman F, Velos P, Pavlin CJ. Ultrasound biomicroscopic analysis of drug-induced bilateral angle-closure glaucoma associated with supraciliary choroidal effusion. Can J Ophthalmol 38: 299–302, 2003.

Generic name: Telithromycin.

Proprietary name: Ketek.

Primary use

A new class of antibacterial agents, ketolides, used in the management of community-acquired pneumonia, acute exacerbation of chronic bronchitis or acute bacterial sinusitis.

Ocular side effects

Systemic administration

Certain

1. Blurred vision

2. Difficulty focusing

3. Delayed accommodation

Probable

1. Visual field disturbance (various scotomas)

2. Myasthenia gravis (aggravates)

a.Diplopia

b.Ptosis

c.Paresis or extraocular muscles

Clinical significance

Telithromycin causes a reversible bilateral central blurred vision and a delay in accommodation, most frequently described as a delay in focusing when adjusting from near to far vision. This occurs in approximately 0.8% of patients and is twice as frequently in women than men. Typically, it first occurs within 1–3 days after starting therapy and at the time of peak blood levels of the drug. The effect occurs within 1–2 hours after dosing and lasts a mean of 2 hours. In some patients this may happen after each dose, but in some patients

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