Price KS, Thompson DM. Localized unilateral periorbital edema induced by aspirin. Comment in Ann Allergy Asthma Immunol 79: 420–422, 1997.

Ruocco V, Pisani M. Induced pemphigus. Arch Dermatol Res 274: 123, 1982.

Sacca SC, Cerqueti PM, et al. Topical use of aspirin in allergic conjunctivitis. Bull Ocul 67(Suppl 4): 193–196. 1988 (Italian).

Schachat AP. Can aspirin be used safely for patients with proliferative ­diabetic retinopathy? Arch Ophthalmol 110: 180, 1992.

Spaeth GL, Nelson LB, Beaudoin AR. Ocular teratology. In: Ocular Anatomy, Embryology and Teratology, Jakobiec FA (ed), JB Lippincott, Philadelphia, p 955–975, 1982.

Tilanus MA, Vaandrager W, Cuyper MH, et al. Relationship between anticoagulant medication and massive intraocular hemorrhage in agerelated macular degeneration. Graefes Arch Clin Exp Ophthalmol 238: 482–485, 2000.

Valentic JP, Leopold IH, Dea FJ. Excretion of salicylic acid into tears following oral administration of aspirin. Ophthalmology 87: 815, 1980.

Wilson HL, Schwartz DM, Bhatt HRF, et al. Statin and aspirin therapy are associated with decreased rates of choroidal neovascularization among patients with age-related macular degeneration. Am J Ophthalmol 137: 615–624, 2004.

Generic names: 1. Codeine; 2. dextropropoxyphene.

Proprietary names: 1. Multi-ingredient preparations only; 2. Darvon.

Bergmanson­ and Rios (1981) reported that darvocet-N, a compound containing dextropropoxyphene and acetaminophen, caused reduce tear secretion, which resulted in soft contact lens dehydration and corneal epithelial abrasion. Weiss (1982) reported bilateral optic atrophy possibly associated with an overdose of Darvon, a compound containing dextropropoxyphene, aspirin and caffeine. Other contributing factors in this patient may have been acidosis, hypokalemia or hypoxia. Cases of transient internuclear ophthalmoplegia (El-Mallakh 1986; Rizzo and Corbett 1983) have been reported, but it is difficult to prove a cause-and-effect relationship. Intravenous naloxone, however, caused the opthalmoplegia to return to normal.

References and Further Reading

Bergmanson JPG, Rios R. Adverse reaction to painkiller in Hydrogel lens wearer. Am Optom Assoc 52: 257, 1981.

El-Mallakh RS. Internuclear ophthalmoplegia with narcotic overdosage. Ann Neurol 20: 107, 1986.

Leslie PJ, Dyson EH, Proudfoot AT. Opiate toxicity after self poisoning with aspirin and codeine. BMJ 292: 96, 1986.

Ostler HB, Conant MA, Groundwater J. Lyell’s disease, the Stevens-Johnson syndrome, and exfoliative dermatitis. Trans Am Ophthalmol Otolaryngol 74: 1254, 1970.

Ponte CD. A suspected case of codeine-induced erythema multiforme. Drug Intell Clin Pharm 17: 128, 1983.

Rizzo M, Corbett J. Bilateral internuclear ophthalmoplegia reversed by naloxone. Arch Neurol 40: 242–243, 1983.

Wall R, Linford SMJ, Akhter MI. Addiction to Distalgesic (dextropropoxyphene). BMJ 280: 1213, 1980.

Weiss IS. Optic atrophy after propoxyphene overdose. Report of a case. Ann Ophthalmol 14: 586, 1982.

Primary use

These mild analgesics are used for the relief of mild to moderate pain. Codeine is also used as an antitussive agent.

Ocular side effects

Systemic administration

Certain

1. Pupils

a.Miosis – acute and toxic states

b.Pinpoint pupils – initial

c.Mydriasis – withdrawal

2. Eyelids or conjunctiva – angioneurotic edema (codeine)

Possible

1. Decreased vision

2. Myopia (codeine)

3. Visual hallucinations

4. Keratoconjunctivitis sicca (dextropropoxyphene)

5. Lacrimation – withdrawal states

6. Eyelids or conjunctiva

a.Erythema multiforme (codeine)

b.Exfoliative dermatitis (codeine)

c.Urticaria (codeine)

Conditional/Unclassified

1. Optic atrophy – toxic states (dextropropoxyphene)

Clinical significance

Codeine and dextropropoxyphene seldom cause significant ­ocular side effects. While codeine may cause miosis, dextropropoxyphene does so only in overdose situations. Visual disturbances are usually insignificant. Cases have been reported to the ­ational Registry of codeine causing transient myopia.

Generic names: Paracetamol (acetaminophen).

Proprietary names: Acephen, Excedrin, Neopap, Tylenol.

Primary use

This para-aminophenol derivative is used in the control of fever and mild pain.

Ocular side effects

Systemic administration

Certain

1. Problems with color vision – objects have yellow tinge 2. Visual hallucinations

3. Green or chocolate discoloration of subconjunctival or retinal blood vessels

4. Pupils

a.Mydriasis – toxic states

b.Decreased reaction to light – toxic states

Probable

1. Eyelids or conjunctiva

a.Allergic reactions

b.Erythema

c.Conjunctivitis – non-specific

d.Edema

e.Angioneurotic edema

f.Urticaria

g.Icterus