Emrich H, et al. Reduced dark-adaptation: An indication of lithium’s neuronal action in humans. Am J Psychiatry 147: 629–631, 1990.

Etminan M, Hemmelgarn B, Delaney JAC, Suissa S. Use of lithium and the risk of injurious motor vehicle crash in elderly adults: case-control study nested within a cohort. BMJ 328: 895–896, 2004.

Fenwick PBC, Robertson R. Changes in the visual evoked potential to pattern reversal with lithium medication. Electroencephalogr Clin Neurophysiol 55: 538, 1983.

Fraunfelder FT. Lithium carbonate therapy and macular degeneration. JAMA 249: 2389, 1983.

Fraunfelder FT, Meyer S. Ocular toxicity of antineoplastic agents. Ophthalmology 90: 1–3, 1983.

Fraunfelder FT, Fraunfelder FW, Jefferson JW. Monograph: the effects of lithium on the human visual system. J Toxicol Cut Ocular Toxicol 11: 97–169, 1992.

Gooding DC, Iacono WG, Katsanis J, et al. The association between lithium carbonate and smooth pursuit eye tracking among first-episode patients with psychotic affective disorders. Psychophysiology 30: 3–9, 1993.

Halmagyi G, et al. Downbeating nystagmus – a review of 62 cases. Arch Neurol 40: 777–784, 1983.

Halmagyi G, et al. Lithium-induced downbeat nystagmus. Am J Ophthalmol 107: 664–679, 1989.

Levine S, Puchalski C. Pseudotumor cerebri associated with lithium therapy in two patients. J Clin Psychiatry 51: 251–253, 1990.

Levy DL, et al. Pharmacologic evidence for specificity of pursuit dysfunction to schizophrenia. Lithium carbonate associated with abnormal pursuit. Arch Gen Psychiatry 42: 335, 1985.

Pakes G. Eye irritation and lithium carbonate. Arch Ophthalmol 98: 930, 1980. Sandyk R. Oculogyric crisis induced by lithium carbonate. Eur Neurol 23:

92, 1984.

Saul RF, Hamburger HA, Selhorst JB. Pseudotumor cerebri secondary to lithium carbonate. JAMA 253: 2869–2870, 1985.

Slonim R, McLarty B. Sixth cranial nerve palsy – unusual presenting symptom of lithium toxicity? Can J Psychiatry 30: 443–444, 1985.

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Ullrich A, et al. Lithium effects on ophthalmological electrophysiological parameters in young healthy volunteers. Acta Psychiatr Scand 72: 113, 1985.

Possible

1. Subconjunctival or retinal hemorrhages secondary to druginduced anemia

2. Visual hallucinations

Conditional/Unclassified

1. Lens – pigmentation

2. Retina – pigmentation

Clinical significance

Neuromuscular reactions, including oculogyric crises, are fairly frequently reported, usually during the first few days of treatment with loxapine. These reactions occasionally require reduction or temporary withdrawal of the drug. The anticholinergic effects

– blurred vision, mydriasis and decreased accommodation – are more likely to occur with concomitant use of antiParkinsonian agents. The possibility of pigmentary retinopathy and lenticular pigmentation from loxapine cannot be excluded but seems quite rare or unlikely.

References and Further Reading

McEvoy GK (ed). American Hospital Formulary Service Drug Information 87, American Society of Hospital Pharmacists, Bethesda, pp 1094–1096, 1987.

Moyano CZ. A double-blind comparison of Loxitane, loxapine succinate and trifluoperazine hydrochloride in chronic schizophrenic patients. Dis Nerv Syst 36: 301, 1975.

Selman FB, McClure RF, Helwig H. Loxapine succinate: a double-blind comparison with haloperidol and placebo in acute schizophrenics. Curr Ther Res 19: 645, 1976.

Sweetmand SC (ed). Martindale: The Complete Drug Reference, 34th edn, Pharmaceutical Press, London, pp 705–706, 2004.

Generic name: Loxapine.

Proprietary name: Loxitane.

Primary use

This dibenzoxazepine derivative represents a subclass of tricyclic antipsychotic agents used in the treatment of schizophrenia.

Ocular side effects

Systemic administration

Certain

1. Oculogyric crises

2. Eyelids or conjunctiva

a.Edema

b.Hyperpigmentation

c.Photosensitivity

d.Urticaria

3. Ptosis

Probable

1. Decreased vision

2. Mydriasis – may precipitate narrow-angle glaucoma 3. Decreased accommodation

Generic name: Pimozide.

Proprietary name: Orap.

Primary use

This diphenylbutylpiperidine derivative is used for suppression of motor and vocal tics of Tourette’s syndrome.

Ocular side effects

Systemic administration

Certain

1. Decreased vision

2. Decreased accommodation

3. Visual hallucinations

4. Oculogyric crises

5. Eyelids

a.Erythema

b.Edema

Probable 

1. Decreased lacrimation

Clinical significance

Up to 20% of patients on this drug have some form of visual disturbance (Physicians’ Desk Reference 2006). This is mainly blurred vision, which is reversible. Decreased accommodation is not uncommon. All ocular side effects are reversible and of