Ocular side effects

Systemic administration

Certain

1. Non-specific ocular irritation

a.Lacrimation

b.Hyperemia

c.Edema

d.Burning sensation

Probable

1. Decreased vision

2. Eyelids or conjunctiva

a.Erythema

b.Conjunctivitis – non-specific

c.Photosensitivity

d.Angioneurotic edema

3. Visual hallucinations

Possible

1. Optic neuritis

2. Alopecia

3. Eyelids or conjunctiva

a.Urticaria

b.Purpura

c.Erythema multiforme

d.Stevens-Johnson syndrome

e.Exfoliative dermatitis

f.Lyell’s syndrome

g.Pemphigoid lesion

h.Eczema

i.Loss of eyelashes or eyebrows

Clinical significance

Piroxicam is one of the most widely prescribed non-steroidal anti-inflammatory drugs and appears to have no serious ocular side effects except a questionable optic neuritis. This possible drug-related event is described by Fraunfelder et al (1994). Piroxicam is one of the few non-steroidal anti-inflammato- ry agents with which intracranial hypertension has not been ­reported. Ocular side effects are infrequent and usually transient. This agent is a strong photosensitizer, and ultraviolet light- ­blocking lenses may be indicated. Patients allergic to thimersol have a high prevalence of piroxicam photosensitivity (Varela et al 1998).

References and Further Reading

Duro JC, et al. Piroxicam-induced erythema multiforme. J Rheumatol 11: 554, 1984.

Fraunfelder FT, Samples JR, Fraunfelder FW. Possible optic nerve side effects­ associated with nonsteroidal anti-inflammatory drugs. J Toxicol Cut Ocular Toxicol 13(4): 311–316, 1994.

Halasz CLG. Photosensitivity to the nonsteroidal anti-inflammatory drug piroxicam. Cutis 39: 37, 1987.

Roujeau JC, et al. Sjogren-like syndrome after drug-induced toxic epidermal necrolysis. Lancet 1: 609, 1985.

Stern RS, Bigby M. An expanded profile of cutaneous reactions to nonsteroidal anti-inflammatory drugs. Reports to a specialty-based system for spontaneous reporting of adverse reactions to drugs. JAMA 252: 1433, 1984.

Varela P, Amorim I, et al. Photosensitivity induced by piroxicam. Acta Med Portuguesa 11(11): 997–1001, 1998.

Vasconcelos C, Magina S, et al. Cutaneous drug reactions to piroxicam. Contact Dermatitis 39(3): 145, 1998.

Class: Mild Analgesics

Generic names: Aspirin (acetylsalicylic acid).

Proprietary names: Bayer aspirin tablets, St Joseph Aspirin,­ Ecotrin enteric coated aspirin.

Primary use

This salicylate is used as an antipyretic analgesic in the management of gout, acute rheumatic fever, rheumatoid arthritis, subacute thyroiditis and renal calculi.

Ocular side effects

Systemic administration

Certain

1. Blurred vision

2. Myopia – transient

3. Drug secreted in tears

a.Sicca – aggravate

b.Superficial punctate keratitis 4. Eyelids or conjunctiva

a.Allergic reactions

b.Conjunctivitis – non-specific

c.Edema

d.Angioneurotic edema

e.Urticaria

f.Purpura

Possible

1. Retina – may increase retinal bleeding (Fig 7.3d) 2. Eyelids or conjunctiva

a.Erythema multiforme

b.Stevens-Johnson syndrome

c.Lyell’s syndrome

d.Pemphigoid lesion

Conditional/Unclassified

1. Cataract – weak cataracogenesis

Toxic states

Certain

1.Problems with color vision

a.Color vision defect – red-green defect

b.Objects have yellow tinge

2.Paralysis of extraocular muscles

3.Diplopia

4.Visual hallucinations

5.Decreased intraocular pressure

6.Nystagmus

7.Pupils

a.Mydriasis

b.Decreased or absent reaction to light

8.Visual field defects

a.Scotomas

b.Constriction

c.Hemianopsia

9.Scintillating scotomas

10. Papilledema

11. Retinal edema

12. Subconjunctival or retinal hemorrhages (Fig. 7.3d) 13. Toxic amblyopia

14. Optic atrophy

arthritis treat to used agents and tagonists• 3 Sectiona narcotic Analgesics,