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Guanethidine

Glaucoma therapy.

Decreased intraocular pressure, local

No known systemic effects

 

 

irritation, miosis, ptosis, decreased

from topical use.

 

 

visual acuity.

 

 

 

 

 

Idoxuridine, trifluridine,

Herpes simplex keratitis

Local irritation, corneal damage, ptosis,

No known systemic effects

vidarabine

 

and obstruction of the punctum lacri-

from topical use.

 

 

male.

 

 

 

 

 

Naphazoline

Symptomatic treatment of

Conjunctival vasoconstriction, local irri-

Rare: headaches, increased

 

allergic or inflammatory reactation, mydriasis, angle closure glau-

blood pressure, nausea, car-

 

tions.

coma, keratitis.

diac arrhythmia.

 

 

 

 

Neostigmine

Glaucoma therapy.

Decreased intraocular pressure, local

No known systemic effects

 

 

irritation, miosis, accommodation

from topical use.

 

 

spasm, decreased visual acuity.

 

 

 

 

 

Penicillin

Ocular bacterial infections.

Local irritations, allergic reactions in

No known systemic effects

 

 

eyelids and conjunctiva.

from topical use.

 

 

 

 

Phenylephrine

Mydriatic.

Mydriasis, angle closure glaucoma,

Increased blood pressure,

 

Vasoconstrictor.

vasoconstriction.

myocardial infarction, tachy-

 

 

 

cardia.

 

 

 

 

Pilocarpine

Glaucoma therapy.

Decreased intraocular pressure, miosis,

Headaches, nausea, bradycar-

 

 

accommodation spasm, decreased

dia, decreased blood pressure,

 

 

visual acuity, retinal tears (rare).

bronchospasm.

 

 

 

 

Rifampicin

Ocular infections with Chlamy-

Conjunctival hyperemia, pain, tearing.

No known systemic effects

 

dia.

 

from topical use.

 

 

 

 

Continued !

553 1 Appendix

Appendix 1 (Continued)

Pharmaceutical

Indications

Ocular effects and side effects

Systemic side effects

 

 

 

 

 

 

 

Confusion, hallucinations.

Scopolamine

Therapeutic mydriasis.

Decreased visual acuity, mydriasis,

 

Uveitis.

angle closure glaucoma, cycloplegia,

 

 

 

increased intraocular pressure.

 

 

 

 

 

Sulfonamide

Ocular bacterial infections.

Local irritation, allergic reaction, ker-

No known systemic effects

 

 

atitis.

from topical use.

 

 

 

 

Tetracycline

Ocular bacterial infections

Unspecific conjunctivitis, allergic reac-

No known systemic effects

 

(including Mycoplasma

tions.

from topical use.

 

strains).

 

 

 

 

 

 

1 Appendix 554

Appendix 2 Non-ophthalmic preparations with ocular side effects

Systemic cardiovascu-

Indications

Ocular effects and side effects

Systemic side effects

lar preparations

 

 

 

 

 

 

 

 

 

 

Tachycardia, agitation, confu-

Atropine

Bradycardic arrhythmia.

Decreased visual acuity, mydriasis,

 

Gastrointestinal spasms.

angle closure glaucoma, visual halluci-

sion.

 

 

nations.

 

 

 

 

 

Amiodarone

Ventricular arrhythmias

Yellowish brown deposits in the cornea,

Thyroid dysfunction, pulmo-

 

that do not respond to

conjunctiva, and lens.

nary fibrosis, photosensitivity.

 

treatment.

 

 

 

 

 

 

Beta blockers

Arterial hypertension.

Decreased visual acuity, visual halluci-

Decreased blood pressure,

 

Coronary heart disease.

nations, decreased intraocular pres-

bradycardia, dyspnea, stupor.

 

Cardiac insufficiency (in

sure, dry eye.

 

 

low doses).

 

 

 

 

 

 

Clonidine

Arterial hypertension.

Decreased intraocular pressure,

Sedation, bradycardia, dry

 

 

decreased visual acuity, allergic reac-

mouth, depressive moods.

 

 

tion in eyelids and conjunctiva.

 

 

 

 

 

Digitalis glycosides

Cardiac insufficiency.

Color vision defects (xanthopsia).

Nausea, bradycardia.

(digoxin, digitoxin,

Cardiac arrhythmia.

 

 

acetyldigoxin)

 

 

 

 

 

 

 

Guanethidine

Arterial hypertension.

Decreased visual acuity, irritation, mio-

Orthostatic circulatory symp-

 

 

sis, ptosis, diplopia, decreased

toms, diarrhea.

 

 

intraocular pressure.

 

 

 

 

 

 

 

 

Continued !

555 2 Appendix

Appendix 2 (Continued)

Systemic CNS prepara-

Indications

Ocular effects and side effects

Systemic side effects

tions

 

 

 

 

 

 

 

 

 

Decreased visual acuity, mydriasis,

Agitated and restless states,

Amphetamines

Narcolepsy.

 

Appetite suppression.

angle closure glaucoma, enlarged

tachycardia, insomnia.

 

Hyperkinetic child syn-

palpebral fissures, visual hallucinations.

 

 

drome (pediatrics).

 

 

 

 

 

 

Barbiturates

Epilepsy.

Ocular motility disturbances

Decreased blood pressure,

 

Anesthesia.

(depressed convergence response,

suppression of REM sleep

 

Tranquilizers and sedatives.

ophthalmoplegia, nystagmus), ptosis,

phases, respiratory depression,

 

 

and blepharoclonus from chronic use.

hyperalgesia.

 

 

 

 

Benzodiazepines (alpra-

Anxiety and agitated

Suppression of corneal reflex,

Respiratory depression,

zolam, diazepam,

states.

depressed accommodation and depth

fatigue, development of toler-

clonazepam, mida-

Epilepsy.

perception, ocular motility distur-

ance.

zolam)

Insomnia.

bances, allergic conjunctivitis.

 

 

 

 

 

Chloral hydrate

Sedative.

Miosis, ptosis, depressed convergence

Irritation of mucous mem-

 

 

response.

branes, liver toxicity.

 

 

 

 

Chlorpromazine,

Schizophrenia.

Decreased visual acuity, pigment

thioridazine, per-

Psychomotor agitation.

deposits on the surface of the lens and

phenazine (group of

Manias.

cornea, changes in the retinal pigment

phenothiazine neu-

Chronic pain syndromes.

epithelium (especially with

roleptics)

 

thioridazine).

 

 

 

Parkinson’s disease, early dyskinesia and tardive dyskinesia, liver damage.

2 Appendix 556

Carbamazepine

Epilepsy.

Diplopia, blurred vision, sensation of

Fatigue, ataxia, blood count

 

Neuralgia (trigeminal

heaviness in the eyelids.

changes.

 

neuralgia).

 

 

 

 

 

 

L-dopa

Parkinson’s disease.

Mydriasis (angle closure glaucoma),

Orthostatic circulatory symp-

 

 

eyelid retraction, ptosis.

toms, nausea, dyskinesia, psy-

 

 

 

chosis.

 

 

 

 

Haloperidol (group of

Schizophrenia.

Mydriasis, decreased visual acuity.

Parkinson’s disease, early dys-

butyrophenone neu-

Psychomotor agitation.

 

kinesia and tardive dyskinesia,

roleptics)

Manias.

 

liver damage.

 

Chronic pain syndromes.

 

 

 

 

 

 

Lithium

Manic phases.

Decreased visual acuity, nystagmus,

Goiter, ataxia, diarrhea,

 

Prophylaxis against endog-

exophthalmos (due to thyroid dysfunc-

tremor.

 

enous depression.

tion).

 

 

 

 

 

Morphine

Severe pain.

Miosis, decreased visual acuity,

Respiratory depression, bron-

 

 

decreased accommodation and conver-

choconstriction, constipation,

 

 

gence reaction. During withdrawal:

euphoria (addictive).

 

 

mydriasis, tearing, and diplopia.

 

 

 

 

 

Phenytoin

Epilepsy.

Nystagmus, decreased visual acuity,

Hypertrichosis, gingival hyper-

 

 

mydriasis.

plasia, cerebral ataxia,

 

 

 

osteopathy.

 

 

 

 

Tricyclic antidepressants

Depression.

Mydriasis, angle closure glaucoma,

Tachycardia, constipation, mic-

(amitriptyline, desi-

 

cycloplegia, dry eyes, diplopia.

turition difficulties.

pramine, imipramine)

 

 

 

 

 

 

 

 

 

 

Continued !

557 2 Appendix

Appendix 2 (Continued)

Systemic medications

Indications

Ocular effects and side effects

Systemic side effects

for treating infection

 

 

 

Indications

 

 

 

 

 

 

 

 

 

Decreased visual acuity, visual field

Aplastic anemia, gastrointesti-

Chloramphenicol

Severe bacterial infections

 

such as abdominal typhus,

changes (scotomas or limitation), optic

nal dysfunction, fever, ›gray

 

Haemophilus influenzae

neuritis or retrobulbar optic neuritis,

syndrome’.

 

meningitis.

local allergic reactions.

 

 

 

 

 

Chloroquine and

Malaria.

Deposits on the cornea, changes in the

Nausea, headache, bleaching

hydroxychloroquine

Amebiasis.

retinal pigment epithelium (bull’s eye

of the hair, blood count

 

 

maculopathy), visual field changes.

changes.

 

 

 

 

Quinine

Malaria infection.

Decreased visual acuity including toxic

Hemolytic anemia, allergic

 

 

amblyopia, mydriasis, retinal damage

reactions, hearing loss.

 

 

(edema or vascular constriction), optic

 

 

 

disk edema, scotomas.

 

 

 

 

 

Ethambutol

Tuberculosis.

Optic neuritis, visual field changes,

Hyperuricemia, nausea.

 

 

color vision defects.

 

 

 

 

 

Isoniazid

Tuberculosis.

Optic neuritis, atrophy of the optic

Polyneuropathy (vitamin B6

 

 

nerve, visual field changes, optic disk

metabolic dysfunction), aller-

 

 

edema, color vision defects.

gic reactions, liver damage.

 

 

 

 

Penicillin

Bacterial infections.

Mydriasis, depressed accommodation,

Nausea, allergic reactions.

 

 

diplopia, optic disk edema with cere-

 

 

 

bral pseudotumor (secondary).

 

 

 

 

 

2 Appendix 558

Rifampicin

Tuberculosis.

Conjunctival hyperemia, blepharocon-

Liver dysfunction, nausea,

 

 

junctivitis, color change (orange) of

allergic reactions, hepatic

 

 

fluid is possible.

enzyme induction.

 

 

 

 

Streptomycin

Tuberculosis.

Nystagmus, decreased visual acuity,

Ototoxicity, nephrotoxicity,

 

 

toxic amblyopia, color vision defect,

allergy.

 

 

atrophy of the optic nerve.

 

 

 

 

 

Sulfonamides

Bacterial infections.

Myopia, unspecific irritation.

Allergic reactions, nausea,

 

 

 

photosensitivity.

 

 

 

 

Tetracycline

Bacterial infections.

Myopia, optic disk edema with cerebral

Nausea, allergic reactions, liver

 

 

pseudotumor, decreased visual acuity,

damage.

 

 

diplopia.

 

 

 

 

 

 

 

 

 

Systemic medications

Indications

Ocular effects and side effects

Systemic side effects

for treating rheumatic

 

 

 

disorders

 

 

 

 

 

 

 

 

 

 

Nausea, headache, bleaching

Chloroquine and

Base medication in rheuma-

Deposits on the cornea, changes in the

hydroxychloroquine

toid arthritis.

retinal pigment epithelium (bull’s eye

of the hair, blood count

 

 

maculopathy), visual field changes.

changes.

 

 

 

 

Gold salts

Base medication in rheuma-

Deposits on the eyelids, conjunctiva,

Blood count changes,

 

toid arthritis.

cornea (chrysiasis), and lens (rare). Pto-

nephrotoxicity, mucous mem-

 

 

sis, nystagmus, and diplopia are rare.

brane damage.

 

 

 

 

 

 

 

Continued !

559 2 Appendix

Appendix 2 (Continued)

Systemic medications

Indications

Ocular effects and side effects

Systemic side effects

for treating rheumatic

 

 

 

disorders

 

 

 

 

 

 

 

 

 

Blurred vision, diplopia, color vision

Damage to gastrointestinal

Ibuprofen

Rheumatoid arthritis.

 

Inflammation in degenera-

defects, dry eyes, optic neuritis (rare).

mucous membranes.

 

tive joint disease.

 

 

 

 

 

 

Indomethacin

Rheumatoid arthritis.

Decreased visual acuity, diplopia, color

Damage to gastrointestinal

 

Inflammation in degenera-

vision defects, corneal deposits.

mucous membranes, head-

 

tive joint disease.

 

aches.

 

 

 

 

Acetylsalicylic acid and

Fever, pain.

Allergies, conjunctivitis, decreased

salicylic acid

Rheumatoid arthritis.

visual acuity, transient blindness.

 

Thrombocyte aggregation

 

 

inhibitor.

 

 

 

 

Hormone preparations

Indications

Ocular effects and side effects

 

 

 

Glucocorticoids

Anaphylactic shock, immu-

Decreased visual acuity, increased

 

nosuppressive therapy

intraocular pressure, posterior sub-

 

(such as in ulcerous colitis

capsular cataract.

 

or immunohemolytic

 

 

anemia).

 

 

Bronchial asthma.

 

 

Acute rheumatic fever.

 

 

 

 

Microscopic gastrointestinal bleeding, allergies, bronchospasm, ototoxic side effects.

Systemic side effects

Increased blood glucose levels, Cushing’s syndrome, osteoporosis, increased risk of thrombosis, increased susceptibility to infection.

2 Appendix 560

Oral contraceptives

Contraception.

 

Regulation of menstrual

 

cycle.

 

 

Other important medications with ocular side effects

Coumarin derivatives Thinning of blood as prophy- (phenprocoumon, warlaxis against and treatment of farin) venous thrombosis.

Decreased visual acuity, retinal vascular Varicosis, migraine, edemas. changes (occlusion, bleeding, spasm),

retinal edema, visual field changes, optic neuritis.

Subconjunctival or retinal bleeding,

Loss of hair, nausea, cerebral

hyphema.

bleeding, spontaneous hema-

 

tomas.

Vitamin A

Vitamin A deficiency.

Loss of eyelashes, increased intracranial

Severe headaches, loss of hair,

 

Acne vulgaris.

pressure (cerebral pseudotumor),

nausea, pruritus, rhagades,

 

 

diplopia, strabismus.

bone and joint pain.

 

 

 

 

Vitamin D

Vitamin D deficiency.

Strabismus, calcium deposits in the

Calcification of parenchymal

 

Hypoparathyroidism.

conjunctiva and cornea (calcific band

organs such as the kidneys.

 

 

keratopathy), atrophy of the optic

 

 

 

nerve due to calcium occlusion of the

 

 

 

optic canal.

 

 

 

 

 

Nicotinic acid

Fat metabolism disorders.

Cystoid maculopathy, decreased visual

Flush symptoms, restlessness,

 

 

acuity, local allergic reactions.

nausea, vomiting, diarrhea.

2 Appendix

561

Appendix 3 Ocular symptoms of poisoning

Toxic substance

Ocular effects and side effects

Systemic side effects

 

 

 

 

 

Dry mouth, dry skin, confusion, tachycardia, hyper-

Atropine

Mydriasis, decreased visual acuity, angle closure

 

glaucoma, cycloplegia, increased intraocular pres-

thermia.

 

sure.

 

 

 

 

Lead

Increased intraocular pressure.

Fatigue, headache and pain in the extremities, pale-

 

 

ness, colic, paralysis, lead halo on the gums.

 

 

 

Quinine

Decreased visual acuity, retinal vascular spasms,

Allergic reactions, hemolytic anemia, vertigo, tinni-

 

atrophy of the optic nerve including blindness.

tus, cyanosis, cardiac death.

 

 

 

Digitalis

Scintillation, patient sees clouds, color vision

Cardiac arrhythmia, (AV conduction blocks,

 

defects.

bigeminy), nausea, vomiting, headaches, confusion.

 

 

 

Ethanol

Transient amblyopia, decreased intraocular pres-

Disturbed gait, disorientation including impaired

 

sure, nystagmus, diplopia, conjunctival hyperemia.

consciousness, cramps, tachycardia.

 

 

 

Methyl alcohol

Atrophy of the optic nerve including blindness.

Nausea, colic, acidosis, oliguria.

 

 

 

3 Appendix 562

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