effects side ocular induced• 7 t-DrugPa r

References and Further Reading

Asherov J, et al. Diplopia following ibuprofen administration. JAMA 248: 649, 1982.

Bernstein HN. Some iatrogenic ocular diseases from systemically administered drugs. Int Ophthalmol Clin 10: 553–619, 1970.

Birch J, et al. Acquired color vision defects. In: Congenital and Acquired Color Vision Defects, Pokorny J et al (eds), Grune & Stratton,

New York, 1979, p 243–350.

Clements D, et al. Colitis associated with ibuprofen. BMJ 301: 987, 1990.

Collum LMT, Bowen DI. Ocular side-effects of ibuprofen. Br J Ophthalmol 55: 472–477, 1971.

Court H, Streete P, Volans GN. Acute poisoning with ibuprofen. Human Toxicol 2: 381, 1983.

Dua HS, Forrester JV. The corneoscleral limbus in human corneal epithelial wound healing. Am J Ophthalmol 110: 646–656, 1990.

Fraunfelder FT. Interim report: National Registry of Possible Drug-Induced Ocular Side Effects. Ophthalmology 87: 87, 1980.

Hamburger HA, Beckman H, Thompson R. Visual evoked potentials and ibuprofen (Motrin) toxicity. Ann Ophthalmol 16: 328, 1984.

Melluish JW, et al. Ibuprofen and visual function. Arch Ophthalmol 93: 781, 1975.

Nicastro NJ. Visual disturbances associated with over-the-counter ibuprofen in three patients. Ann Ophthalmol 29: 447–450, 1989.

Palmer CAL. Toxic amblyopia from ibuprofen. BMJ 3: 765, 1972. Palungwachira P, Palungwachira P, Ogawa H. Localized periorbital edema

induced by ibuprofen. J Dermatol 32: 969–971, 2005.

Quinn JP, et al. Eosinophilic meningitis and ibuprofen therapy. Neurology 34: 108, 1984.

Ravi S, et al. Colitis caused by non-steroidal anti-inflammatory drugs. Postgrad Med J 62: 773–776, 1986.

Szmyd L, Perry HD. Keratopathy associated with the use of naproxen. Am J Ophthalmol 99: 598, 1985.

Tullio CJ. Ibuprofen-induced visual disturbance. Am J Hosp Pharm 38: 1362, 1981.

Generic name: Indometacin (indomethacin).

Proprietary names: Indocin, Indocin SR, Indo-lemmon, Indomethegan G.

Primary use

Systemic

This non-steroidal anti-inflammatory drug is a methylated indole derivative used as an antipyretic, analgesic or anti-inflammatory agent in the treatment of rheumatoid arthritis, rheumatoid spondylitis and degenerative joint disease.

Ophthalmic

Indometacin has been advocated for the treatment of cystoid macular edema or preoperatively to enhance mydriasis at cataract surgery. It has also been advocated in the management of symptoms due to corneal scars, edema, erosions or post refractory surgery pain.

Ocular side effects

Systemic administration

Certain

1. Blurred vision – transitory

2. Conjunctiva and cornea

a.Irritation

b.Keratitis

c.Corneal deposits

d.Corneal erosions

Fig. 7.3c  Indomethacin induced macular pigment mottling.

3. Abnormal ERG or EOG

4. Problems with color vision – color blue defect, yellow defect

5. Retina or macula

a.Edema

b.Degeneration

c.Pigment mottling (Fig. 7.3c) 6. Visual fields

a.Scotoma

b.Constriction

c.Enlarged blind spot

Possible

1. Intracranial hypertension

a.Papilledema

b.6th nerve palsy 2. Optic neuritis

3. Induced anemia

a.Conjunctival – hemorrhages

b.Retinal – hemorrhages

Local ophthalmic use or exposure - topical ocular

Certain

1. Irritation

a. Burning sensation

2. Superficial punctate keratitis

3. Eyelids

a.Edema

b.Erythema

c.Contact dermatitis

4. Decreases miosis during intraocular surgery (weak)

5. Local anesthesia

Clinical significance

Indometacin has been used for over four decades with few ocular side effects unless the drug is used for prolonged periods in high doses. Its most serious side effect is retinal pigmentary retinopathy, with macular atrophy and a waxy disk (Burns 1968; Henkes et al 1972). This is associated with depressed ERG and constricted visual fields. While blurred vision may occur after starting this agent, seldom is it of clinical significance. The