OCULAR MEDICATIONS . . . CONT.
Corticosteroids
never prescribed by primary care physician unless emergency indications
complications
•potentiates herpes simplex keratitis and fungal keratitis as well as masking symptoms (within days)
•posterior subcapsular cataract (within months)
•increased IOP, more rapidly in steroid responders (within weeks)
Antibiotics
indications: bacterial conjuntivitis, keratitis, or blepharitis
commonly as topical drops or ointments, may give systemically
e.g. sulfonamide (sodium sulfacetamide, sulfisoxazole), gentamicin, erythromycin, tetracycline, bacitracin, polymyxin
OCULAR DRUG TOXICITY
Table 7. Drugs with Ocular Toxicity
Amiodarone |
Corneal microdeposits and superficial keratopathy |
Chloroquine |
Bull’s eye lesion at macula |
|
Secondary keratopathy |
Chlorpromazine |
Anterior subcapsular cataract |
Contraceptive Pills |
Decreased tolerance to contact lenses |
|
Migraine |
|
Optic neuritis |
|
Central vein occlusion |
Digitalis |
Yellow vision |
|
Blurred vision |
Ethambutol |
Optic neuropathy |
Haloperidol (Haldol) |
Oculogyric crises |
|
Blurred vision |
Indomethacin |
Superficial keratopathy |
Isoniazid |
Optic neuropathy |
Nalidixic Acid |
Papilloedema |
Steroids |
Posterior subcapsular cataracts |
|
Glaucoma |
|
Papilloedema (systemic steroids) |
|
Increased severity of HSV infections (geographic ulcers) |
|
Predisposition to fungal infections |
Tetracycline |
Papilloedema |
Thioridazine |
Pigmentary degeneration of retina |
Vitamin A Intoxication |
Papilloedema |
Vitamin D Intoxication |
Band keratopathy |
|
|
REFERENCES
Coakes R, and Holmes Sellors P. Outline of Ophthalmology. 2nd Edition. 1995. Butterworth-Heinemann Ltd.: Oxford.
Stein R, Stein H, and Slat B. Management of Ocular Emergencies. 2nd Edition. 1994. An Allergen Handbook.
Vaugha D, Asbury T, and Piordan-Eva P. General Ophthalmology. 15th Edition. 1999. Prentice Hall Canada: Toronto.
OP40 – Ophthalmology |
MCCQE 2002 Review Notes |