Soalan

2
:
Terangkan
mengakibatkan eye oedema.

bagaimana

penggunaan

antikolinergik

Edema may be found in the cornea of the eyes with glaucoma, severe conjunctivitis
or keratitis or post-surgery. Patients may perceive colored haloes around bright
lights. Edema surrounding the eyes is called periorbital edema or eye puffiness. The
periorbital tissues are most noticeably swollen immediately after waking, perhaps
as a result of the gravitational redistribution of fluid in the horizontal position.
Anticholinergics drugs but also sedative drugs like antipsychotics and
anticonvulsants. The onset of the effect of these drugs can be quite slow. Drugs in
the adrenergic and anticholinergic categories can cause dilatation of pupil.
Signs of tear film insufficiency include superficial punctate-keratopathy,
reduced tear break-up time, and decreased production of tears as measured by the
Schirmer's test. Various medications, such as oral antihistamines, can exacerbate
tear film insufficiency because they cause a decrease in tear production due to their
anticholinergic effects.
Drug toxicity to the ocular surface can manifest as epithelial keratopathy,
corneal edema and altered tear film quantity and quality. Timely and appropriate
management of these complications can prevent permanent ocular surface damage
and impaired vision. Early recognition can ensure the patient is able to continue the
appropriate treatment for their underlying disorder.
Phenothiazines (typical antipsychotics), for example, can cause phototoxic
lysis of the corneal endothelium. This is linked to total dosage of medication. This
can lead to impaired endothelial pump function, causing severe corneal edema and
consequent severe visual effects. Visual impairment is irreversible without prompt
identification and cessation of the medication.
Chlorpromazine in particular, a member of the phenothiazine family, has
been noted to cause corneal epithelial keratopathy. The manifestation seen with
chlorpromazine use is noted to have a distinctive pattern of swirling lines or fine
streaks in the epithelium, reminiscent of Plaquenil (Covis Pharmaceuticals)
keratopathy. This presentation has been linked to high dosages (>2g/day) of the
medication. The condition elicits minimal visual consequences and usually regresses
with appropriate intervention, such as dose tapering.

References:
1. http://www.richmondeye.com/ocular-side-effects-of-medications/
2. Kessler RC, Berglund P, Demler O, et al. Lifetime prevalence and age-of-onset
distributions of DSM-IV disorders in the National Comorbidity Survey Replication.
Arch Gen Psychiatry. 2005 June;62(6):593-602.
3. American Psychiatric Association DSM-5 Development. 2014. Accessed
November 22, 2015.www.dsm5.org/about/Pages/DSMVOverview.aspx.
4. Greenshaw, AJ. Neurotransmitter interactions in psychotropic drug action:
beyond dopamine and serotonin. J Psychiatry Neurosci. 2003 Jul; 28(4):247-250.
5. Li J, Tripathi RC, Tripathi BJ. Drug-induced ocular disorders. Drug Saf.
2008;31(2):127-41.
6. Johnson AW, Buffaloe WJ. Chlorpromazine epithelial keratopathy. Arch
Ophthalmol. 1966;76(5):664-7.