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drug. Pupillary reactions occur primarily in overdose situations. Nystagmus has been associated with phenelzine or tranyl­ cypromine, and visual hallucinations by phenelzine therapy.

References and Further Reading

Drugs for psychiatric disorders. Med Lett Drugs Ther 25: 45, 1983. Drugs that cause photosensitivity. Med Lett Drugs Ther 28: 51, 1986. Kaeser HE. Drug-induced myasthenic syndromes. Acta Neurol Scand

70(Suppl. 100): 39, 1984.

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Shader RI, Greenblatt DJ. The reappearance of a monamine oxidase inhibitor. J Clin Psychopharmacol 19(2): 105–106, 1999.

Thomann P, Hess R. Toxicology of antidepressant drugs. Handbk Exp Pharmacol­ 55: 527, 1980.

Weaver KEC. Amoxapine overdose. J Clin Psychiatry 46: 545, 1985. Zaratzian VL. Psychotropic drugs – neurotoxicity. Clin Toxicol 17: 231, 1980.

Generic names: 1. Isocarboxazid; 2. phenelzine; 3. tranylcypromine.

Proprietary names: 1. Marplan; 2. Nadril; 3. Parnate.

Primary use

These monoamine oxidase inhibitors are used in the symptomatic relief of reactive or endogenous depression.

Ocular side effects

Systemic administration

Certain

1. Visual hallucinations (phenelzine)

Probable

1. Decreased vision

2. Mydriasis (primarily overdose)

3. Extraocular muscles

a.Diplopia

b.Nystagmus (phenelzine, tranylcypromine)

c.Strabismus

4. Myasthenia gravis

a.Diplopia

b.Ptosis

c.Paresis of extraocular muscles 5. Photophobia

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

7. Eyelids – photosensitivity

8. Visual field defects (tranylcypromine)

Possible

1. Subconjunctival or retinal hemorrhages secondary to druginduced anemia

2. Eyelids or conjunctiva – lupoid syndrome

Clinical significance

Ocular side effects due to these monoamine oxidase inhibitors are reversible and usually insignificant. All of these drugs may cause blurred vision, which only rarely requires stopping of the

Generic names: Maprotiline.

Proprietary name: Generic only.

Primary use

This tetracyclic antidepressant is used in the treatment of depression.

Ocular side effects

Systemic administration

Certain

1. Decreased vision

2. Decreased accommodation

3. Visual hallucinations

4. Mydriasis – may precipitate narrow-angle glaucoma

Probable

1.Eyelids or conjunctiva

a.Erythema

b.Conjunctivitis – non-specific

c.Edema

d.Photosensitivity

e.Angioneurotic edema

f.Urticaria

Possible

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

2. Eyelids or conjunctiva – erythema multiforme

Conditional/Unclassified

1. Palinopsia

2. Illusory visual spread

Clinical significance

Adverse ocular reactions due to these tetracyclic antidepressants are seldom of major clinical significance. Anticholinergic effects are the most frequent and include blurred vision, disturbance of accommodation and mydriasis. Several instances of increased intraocular pressure have been reported to the National Registry following pupillary dilatation in patients on maprotiline. Visual hallucinations are usually associated with drug overdosage.