Drugs & ophthalmology

Girls work from

Dr.Sameer jamal lectures records
2010
( )
Eye Drugs
Systemic
side effect
Systemic
Drugs
Eyes side
effect
Eye drops can help or kill the patient
There are well known systemic drugs that has
a serious effects on the eye. So , as a GP u
have to be aware of them and refer the pt. to
ophthalmologist from the beginning.
Systemic medications side effects on the eye
usually bilateral blindness.
You should ask about the eye drops when you
take a drugs history from the pt.
Drugs category:
1- Parasympathomimetics
2- Parasympatholytics.
3- sympathomimetics
4- sympatholytics
5- Antibiotic, antiviral, anti fungus
6- NSAID
7- Steroid
8- Antiglaucoma , antiallergic.
9- Decongested: as prozolin
- its off counter medications and its a vasoconstrictor, it just will treat the sign not the
problem .
- So as a GP never prescribe it for your pt. and never prescribe any vasoconstrictors drops
its the ophthalmologist job.
-


Chronic red eye for life.



Parasympathomimetics: it constrict the
pupils
Drugs Uses Side Effect
1-pilocarpine 1- glaucoma
2- pupil constrictor
3-accommodative
esotropia
1- GIT upset
2- lacrimation and salivation
3- anesthesia apnea: in anesthesia
we use succinilcoline as muscle
relaxant and the esterase enzyme
break it but if the pt. was on
Echothiophate his body will not
respond to the esterase enzyme so
the apnea will be prolonged and
the pt. will die.
Because of that u have to take a
good drugs history before any
operations. Especially in pts. With
Glaucoma
2-Echothiophate
Parasympatholytics
Drugs Uses Side Effect
1- Atropin
-homatropine
2-cyclogyl
3- Mydriacyl
( tropicamide) is the only
one can be prescribed by a
GP because it has less side
effects
1- pupil dilator

2- refraction: to identify
the power of the patients
glasses correctly in < 20
years pt.

3- uveitis: coz iris stick to
the lens it will give
irregular pupil so we dilate
the pupil to prevent it from
stickness
1- Dizziness
2- fever
3- nausea
4- vomiting
5- hallucinations
6- AACA
(Acute angel closure
glaucoma)
- Any drugs can dilate the
pupil could induce AACG so
dont induce dilatation
unless u have to
7- tachycardia

sympathomimitics
Drugs Uses Side Effect
-Phenylephrine


- Alphagan:is an epinephrin
derivative
-Pupil dilatations


- treatment of Glaucoma
-Acute MI
- acute hypertension.
- arrhythmias

Sympatholytics
Every eye medications can cause any problems
It may ( vascular , respiratory , Gastric, Brain ant
ect.)
Drugs Uses Side Effect
- timolol
-
-Glaucoma

-Hypotension
- arrhythmias




For a GP Dont :
1- dilate the pupil unless you have to: if you want to use just use
Mydriacyl and one drop in each eye.
2- use combination antibiotics drops:
- because if the patient develop sensitivity you will not know from
witch one.
3- use antibiotics with steroid
4- Use steroid: topical steroid is not for GP its the job of
ophthalmologist because the complications is a lot.
5- Use decongestant.
NB:
- Drops on eye is like an IV.
- Ask your pt. what eye medications he is on.
- The most common ocular condition the GP treated is Acute
conjunctivitis ttt by topical antibiotics qid.
Systemic toxicity to the eye form
systemic medications
Steroid complications :
- Cataract
- Glaucoma
NB: its just a matter of time, the longer the pt. on
steroid the more likely he is going to develop
cataract and glaucoma.
- If the pt. is going to use steroid for more than 4
weeks so he must see the ophthalmologist , but
for short term use (3-4) days it doesnt matter.
Ethamabutolo: its anti Tb
A lot of pt. loss their vision permanently form it , so any pt. is
going to start with antituberculous .He must have a full eye
examination from the beginning and follow up with the
ophthalmologist
Toxic it can cause Optic Neuropathy
Its Dose related





it can improved and it can be permanent.
INH is anti tb drugs but it has less side effect than
Ethamabutolo.
Dose Incidence (pt. may develop optic Neuropathy)
15mg/kg/day < 1 %
25mg/kg/day 5 %
50mg/kg/day 25 %
Systemic anti cancer agents
Tamoxifen citrate (Nolvadex)
Cyclosporine
They can cause maculopathy and interfere with
vision.
- their side effects are reversible
Chloroquine: is anti malaria and its used also
in ttt of Rheumatoid arthritis and SLE
Macular toxicity
Bulls eye maculopathy
- Cumulative dose is:
300 g total dose
- Daily dose:
250 mg / day
Irreversible
The pt. must be seen by the ophthalmologist
before he start these drugs because its dose
related.
Digitalis
Symptoms of digitalis toxicity that you have to
counsel the pt. about them are :
- Xanthopsia
- Blurred vision
- White halos
- Flash lights
NB: digitalis toxicity it doesnt cause permanent
visual loss.
OCP
It can cause :
- Vascular eye and brain occlusion
- Migrain
- Ischemic optic neuropathy
- Pseudotumor cerebri:its the most common
complication associated with oral
contraceptive pills.

Amiodarone is an antiarrhythmic agent.
- It affect cornea and ON and it can cause optic
neuropathy.

Antipsychotics: can affect the vision by
involving the macula.

Phenytoin (diphenylhydantoin) is antiepileptic
drugs. Is the commenst one can cause
ophthalmoplegia and nystagmus.