Monday | June 26, 2017
High Risk Medications
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medicationsMedications have an established profile of side effects, but ocular side effects are often unrecognized, overlooked or misdiagnosed. While the ophthalmologic literature usually highlights such discoveries, the general medical journals don't always pass the message along. Since ocular side effects can be severe, it's essential that patients inform their optometric physician of all medications they are taking. Some adverse reactions can be mistaken as symptoms of stroke or other diseases, causing unnecessary confusion.

Our doctors will alert you of any possible ocular side effect and maintain close communication with your primary care physician so that we can all work together in recognizing the signs and symptoms of potential adverse events. This allows us to correct the underlying problem or adjust the treatment regimen without that unnecessary confusion and possible costly testing to determine the cause of the symptoms.

 

The following is a list of medications which are known to have high risk of ocular side effects

If you are currently, or begin taking any of these medications, please contact our office to schedule an appointment or so that your doctor can review your ocular history for any possible ocular threats associated with your eye health.

 

Acutane

 

Used to treat acne. Ocular side effects of dry eyes, eye redness, burning, blurred vision, temporary visual disturbances, and night vision troubles. Patients should have yearly eye exams if taking this medication or if any symptoms are noticed.


Alcohol, Excessive Use

 

Ocular side effects include night vision problems, decreased focusing ability, and double vision.  Patients should not use alcohol excessively or drink and drive.  Patients should be examined if symptoms are noted.


Amiodarone

 

Used as a cardiac medication. Ocular side effects including corneal changes and glare, with optic neuritis or optic neuropathy not clearly established as a side effect. Patients should have yearly eye exams if taking this medication or if any symptoms are noticed.


Amitriptyline

 

Used to treat depression. Ocular side effects include dry eyes, decrease in accommodation (focusing) while reading, and acute angle closure glaucoma which causes eye pain, eye redness, and seeing rainbows around lights with or without vomiting or nausea. Patients should be examined to determine if amitriptyline are safe to use.


Antihistamines, OTC

 

Used for allergies. Side effects may include dry eyes and blurred vision.  The most serious side effect is angle closure glaucoma which causes eye pain, eye redness, and seeing rainbows around lights with or without vomiting or nausea.  Patients should be examined to determine if antihistamines would be safe to use.


Antipsychotic medications (Risperdal, Abilify Geodon, and Clozapine)

 

Used to treat certain schizophrenia and bipolar diseases.  An ocular side effect is acute angle closure glaucoma which causes eye pain, eye redness, and seeing rainbows around lights with or without vomiting or nausea.  Patients should be examined to determine if antipsychotic medications are safe to use.


Aspirin

 

Used as a blood thinner “anticoagulant”.  Ocular side effects can increase bleeding in or around the eye, such as subconjunctival hemorrhage or eyelid bruising.  May also increase bleeding if there is a retinal vessel hemorrhage. Patients should have yearly eye exams if taking this medication or if any symptoms are noticed.


Chlopropamide

 

Used for diabetic patients.  A rare ocular side effect known to occur is optic nerve degeneration.  Patients should be examined prior to using this medication and yearly while taking this medication to monitor for optic nerve toxicity. 

 

Chloroquine

Used to treat malaria and arthritic conditions.  Ocular side effects include optic nerve degeneration, retinal degeneration, blurred central vision, and color vision changes.  Patients should be examined prior to using the medications and then every year to monitor for retinal toxicity.

 

Chlorpromazine

 

Used as a psychiatric medication.  Ocular side effects include pigmentary changes on the conjunctiva, cornea, eyelids, and in the retina can occur if taken in large dosages.  Patients should be examined yearly while on this medication to monitor for any ocular changes.


Cialis

 

Used for erectile dysfunction.  Ocular side effects include optic neuropathy, color vision changes, dry eyes, eye hemorrhage, eye pain, and light sensitivity.  Patients should be examined yearly if taking this medication.


Cimetidine

 

Used as an anti-ulcer medication. A rare ocular side effect of angle closure glaucoma can occur which will cause eye pain, eye redness, and seeing rainbows around lights with or without vomiting or nausea. Patients should be examined to determine if cimetidine medications are safe to use.


Digitalis

 

Used as a cardiac medication.  Ocular side effects include glare and halos around lights with overdoses leading to yellowish vision.  Patients should be monitored yearly while on this medication.


Digoxin

 

Used to treat various heart conditions.  Ocular side effects include color vision changes, blurred vision, and other visual disturbances. Patients should have yearly eye exams if taking this medication or if any symptoms are noticed.


Enbrel

 

Used for certain arthritis conditions.  Ocular side effects include dry eyes, ocular inflammation, and uveitis. Patients should be examined yearly if taking this medication or immediately if any symptoms are noticed.


Ephedrine

 

Used for appetite suppressant, stimulant, decongestant, and concentration aid. Ocular side effects include eye pain, hallucinations, headaches, and pupil dilatation which could lead to acute angle closure glaucoma. Patients should be evaluated before beginning treatment to make sure the medication is safe to use or if the above signs or symptoms are noticed.


Ethambutal

 

Used for Tuberculosis. Ocular side effect can lead to the degeneration of the optic nerve. Patients should have yearly eye exams if taking this medication or if any symptoms are noticed.


5-Fluoro-Uracil

 

Used for cancer patients as a chemotherapeutic agent. The most common ocular side effect is spontaneous tearing as the medication can lead to scarring and closure of the nasolacrimal opening (the tear drainage system). Patients should have yearly eye exams if taking this medication or if any symptoms are noticed.


Flomax

 

Used for men to treat enlarged prostate (BPH). Ocular side effects include blurred vision and may cause intraoperative floppy iris syndrome making cataract surgery more difficult. Patients should have yearly eye exams if taking this medication or if any symptoms are noticed.


Flovent

 

Used to prevent difficulty breathing, chest tightness, and coughing or wheezing caused by asthma. Ocular side effects include cataracts and glaucoma. Patients should have yearly eye exams if taking this medication or if any symptoms are noticed.


Fosamax

 

Used to treat and prevent osteoporosis. Ocular side effects include eye pain, eye redness, ptosis, yellow color disturbances, and double vision. Patients should be evaluated prior to using this medication and then yearly while taking this medication.


Haldol

 

Used as a sedative medication for psychiatric patients. Ocular side effects include decreased tear production, decreased focusing ability, and pupil dilation which could lead to angle closure glaucoma which causes eye pain, eye redness, and seeing rainbows around lights with or without vomiting or nausea. Patients should be evaluated before beginning treatment to make sure the medication is safe to use or if the above signs or symptoms are noticed.


Humira

 

Used for Rheumatoid arthritis, Crohn’s disease, or psoriasis. Ocular side effects include blurred vision, pain or tenderness around the eyes, and sunken eyes. Patients should have yearly eye exams if taking this medication or if any symptoms are noticed.


Hydrocortison

 

Used for serious eye or ear infections. Ocular side effects include burning, irritation, swelling, itching, redness, pain, or vision changes. Patients should have yearly eye exams while taking this medication.


Indomethacin

 

Used as an anti-inflammatory medication. Ocular side effect includes whorl-like changes on the cornea. Patients should have yearly eye exams while taking this medication.


Isoniazide

 

Used to treat tuberculosis. Ocular side effect includes optic nerve degeneration. Patients should have yearly eye exams while taking this medication.


Levitra

 

Used for erectile dysfunction. Ocular side effects include optic neuropathy, color vision changes, dry eyes, eye hemorrhage, eye pain, and light sensitivity. Patients should be examined yearly if taking this medication.


Methylprednisone

 

Used as an anti-inflammatory. Ocular side effects include glaucoma, vision changes, and eye pain. Patients should have yearly eye exams while taking this medication.


Minocycline

 

Used for acne and rosacea. Ocular side effects may cause the sclera, the white part of your eye, to become pigmented. Typically it is a blue-gray discoloration. Sunlight might worsen the pigmentation. Patients should have yearly eye exams while taking this medication or if any noticeable pigmentation occurs.


Nalidixic Acid

 

Used to treat urinary tract infections. Ocular side effects include visual disturbances, swollen optic nerve(s), and headaches due to increased fluid in the brain, “pseudotumor cerebri”. Patients should have yearly eye exams while taking this medication or if any of the above symptoms are noted, patients should be evaluated same day. 


Niacin

 

Used to help control cholesterol levels. Ocular side effects include blurred or distorted vision due to the medication causing swelling in the retina. Patients should be evaluated soon after beginning the medication and then yearly while taking this medication. Patients should also home monitor using the Amsler grid.


Oral contraceptives

 

Used for birth control. Ocular side effects include retinal vascular problems, blurred vision, headaches, dry eyes, and pseudotumor cerebri (as mentioned above in the Nalidixic acid section). Patients should be seen yearly while taking this medication.


Plaquenil (Hydroxychloroquine)

 

Used for Rheumatological conditions (rheumatoid arthritis or lupus). Ocular side effects include blurred or distorted vision, decrease in color vision, blind spots, changes in the central visual area (macula), and halos around lights. Patients should be examined soon after beginning Plaquenil and every year or sooner to monitor for toxicity. Patients should also home monitor using an Amsler grid.


Prednisone

 

Used in many applications such as for low corticosteroid levels, multiple sclerosis, lupus, arthritis, and severe allergic reactions. Ocular side effects include glaucoma, cataracts, and eye pain or redness. Patients should have their intraocular pressure monitored closely if taking this medication long-term.


Pulmicort

 

Used to help with wheezing, shortness of breath, or trouble breathing due to asthma or lung diseases. Ocular side effects include blurred vision and red, swollen, itchy, or watery eyes. Patients should have yearly eye exams while taking this medication.


Quinine

 

Used to treat malaria. Ocular side effects include difficulty with night vision, if pregnant can damage the fetus’ optic nerves. Patients should have yearly eye exam while taking this medication.


Remicade

 

Used for rheumatoid arthritis. Ocular side effects include vision changes, eye pain, and redness upon eye movement. Patients should be examined if these symptoms are noticed.


Rifabutin

 

Used to treat infections that occur in HIV positive people. Ocular side effects include iritis or uveitis, an inflammation inside the eye causing pain to light, blurred vision, and sometimes redness. Patients should be evaluated immediately if you are experiencing any of these symptoms.


Scopolamine Patch

 

Used as a patch behind the ear to help with motion sickness. Ocular side effects include papillary dilation for 3-5 days, which will cause a loss of focusing ability. Patients should be aware not to rub their eyes during/after handling the patch.


Seroquel

 

Used to treat certain schizophrenia and bipolar diseases. An ocular side effect is acute angle closure glaucoma causing eye pain, eye redness, seeing rainbows around lights with or without vomiting or nausea. Patients should be examined to determine if antipsychotic medications are safe to use.


Synthroid (levothyroxin)

 

Used to treat hypothyroidism. Ocular side effects include blurred vision, double vision, light sensitivity, and lid drooping. Patients should be examined yearly while taking this medication or if you experience any of these symptoms.


Tobacco

 

Ocular side effects include cataracts, increase macular degeneration, and dry eyes. Patients should not use tobacco. Patients should have yearly eye exams if they smoke or had previously smoked.


Tamoxifen

 

Used for treatments in breast cancer. Ocular side effects include crystalline retinopathy, corneal changes and optic neuritis. Patients should be examined at the beginning of treatment and monitored closely while taking the medications.


Tetracycline

 

Used as an antibiotic medication to treat pneumonia, respitory tract infection, acne, and many more. Ocular side effects include blurred vision, burning, redness, and swelling. Patients should be examined right away if taking this medication and notice any unusual symptoms. This drug should not be taken by pregnant women or women trying to get pregnant, children under 8 years old as it may cause permanent teeth discoloration, or if you have an allergy to sulfites minocycline, doxycycline, or tetracycline medications.


Thioridazine

 

Used for schizophrenic patients. Ocular side effects include blurred vision, night vision problems, decreased color vision, and retinal changes, which may happen within 2-8 weeks of beginning medication. Patients should be evaluated as soon as they begin the medication and monitored closely for visual changes.


Topamax

 

Used to treat seizures or epilepsy. Ocular side effects include sudden decrease in vision and acute angle closure glaucoma which causes eye pain, eye redness, and seeing rainbows around lights with or without vomiting or nausea. Patients should be evaluated before beginning treatment to make sure the medication is safe to use or if the above signs or symptoms are noticed.


Viagra

 

Used for erectile dysfunction. Ocular side effects include optic neuropathy, color vision changes, dry eyes, eye hemorrhage, eye pain, and light sensitivity. Patients should be examined yearly if taking this medication.


 
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