Clinical significance

Adverse ocular effects due to these drugs, although not uncommon, are rarely significant. All ocular side effects are reversible and transitory. Difficulty in focusing is probably the most frequent complaint.

References and Further Reading

Acute drug abuse reactions. Med Lett Drugs Ther 27: 77, 1985. De Cuyper C, Goeteyn M. Systemic contact dermatitis from

subcutaneous hydromorphone. Contact Dermatitis 27(4): 220–223, 1992.

Drug Evaluations, 6th edn, American Medical Association, Chicago, p 59, 1986.

Gilman AG, Goodman LS, Gilman A (eds). The Pharmacological Basis of Therapeutics. 6th edn. Macmillan, New York, pp 495–511, 1980.

Katcher J, Walsh D. Opioid-induced itching: morphine sulfate and hydromorphone hydrochloride. J Pain Symptom Manage 17(1): 70–72, 1999.

Sweetman SC (ed). Martindale: The Complete Drug Reference. 34th edn. ­Pharmaceutical Press, London, pp 45–76, 2004.

infants of methadone-dependent mothers to be at least 10 times greater then that seen in the general population.

References and Further Reading

Gill AC, Oei J, Lewis NL, et al. Strabismus in infants of opiate-dependent mothers. Acta Paediatr 92: 379-385, 2003.

Linzmayer L, Fischer G, Grunberger J. Pupillary diameter and pupillary reactions in heroin dependent patients and in patients participating in a methadone and morphine replacement program. Weiner Medizinische Wochenschrift 147(3): 67-69, 1997.

Murphy SB, Jackson WB, Pare JAP. Talc retinopathy. Can J Ophthalmol 13: 152, 1978.

Nelson LB, et al. Occurrence of strabismus in infants born to drugdependent women. Am J Dis Child 141: 175-178, 1987.

Ratcliffe SC. Methadone poisoning in a child. BMJ 1: 1056-1070, 1963.

Rothenberg S, et al. Methadone depression of visual signal detection performance. Pharmacol Biochem Behav 11: 521, 1979.

Rothenberg S, et al. Specific oculomotor deficit after acute methadone. I. Saccadic eye movements. Psychopharmacology 67: 221,

1980.

Rothenberg S, et al. Specific oculomotor deficit after acute methadone. II. Smooth pursuit eye movements. Psychopharmacology 67: 229, 1980.

Sweetmand SC (ed). Martindale: The Complete Drug Reference. 34th edn. Pharmaceutical Press, London, pp 57-59, 2004.

Generic name: Methadone hydrochloride.

Proprietary names: Dolophine hydrochloride, Methadose.

Street names: Dolly, doses, juice, meth.

Primary use

This synthetic analgesic is useful in the treatment of chronic painful conditions and in the detoxification treatment of patients dependent on heroin or other morphine-like agents.

Ocular side effects

Systemic administration

Certain

1. Pupils

a.Miosis – toxic states

b.Pinpoint pupils – toxic states

c.Mydriasis – withdrawal states 2. Talc retinopathy (intravenous)

3. Decreased vision

4. Decreased spontaneous eye movements

Probable

1. Eyelids – urticaria

Ocular teratogenic effects

Certain

1. Increased incidences of strabismus

Clinical significance

Methadone seldom causes significant ocular side effects. Miosis is uncommon but may occur at therapeutic dosages. In severe toxic states, there may be ‘pinpoint’ pupils. Talc emboli, appearing as small white glistening dots in the macular area, have been reported in addicts who intravenously inject oral medications that contain talc as a filler. A case of cortical blindness, apparently secondary to anoxia, has been reported in a child who experienced severe respiratory depression. Nelson et al (1987) and Gill et al (2003) reported the incidence of strabismus in

Generic names: 1. Morphine; 2. opium.

Proprietary names: 1. Astramorph PF, Avinza, DepoDur, Duramorph PF, Infumorph, Kadian, MS Contin, Oramorph SR.

Street names: 1. M, morf, white stuff; 2. joy plant, pen yan, skee.

Primary use

These opioids are used for the relief of severe pain. Morphine is the alkaloid that gives opium its analgesic action.

Ocular side effects

Systemic administration

Certain

1. Pupils

a.Miosis

b.Pinpoint pupils – toxic states

c.Mydriasis – withdrawal or extreme toxic states

d.Irregularity – withdrawal states

2. Decreased vision

3. Decreased accommodation

4. Decreased convergence

5. Decreased intraocular pressure

6. Visual hallucinations

7. Lacrimation

a.Increased – withdrawal states

b.Decreased

8. Eyelids or conjunctiva

a.Allergic reactions

b.Conjunctivitis – non-specific