Exploring Ocular Side Effects

Ophthalmologists and optometrists spend the majority of their time in patient care. Supporting our patients isn’t just limited to exams, procedures, and follow-ups - it extends to an understanding of the individual’s medical history and how the systemic drugs they may be using can contribute to ocular side effects. In this blog, we’ll discuss commonly prescribed systemic medications with ocular side effects and what you should be on the lookout for.  

Sometimes we’ll see a patient with ocular conditions that have no apparent cause. These are times when it is vitally important to consider the systemic medications they may be using. As you’re already aware, many patients will not be forthcoming with the medicines, herbal supplements, and other drugs they may be taking.

Plaquenil

Plaquenil (hydroxychloroquine, Sanofi-Aventis) is prescribed to treat conditions such as systemic lupus erythematosus, Sjögren’s syndrome, and rheumatoid arthritis. The use of the drug carries the potential risk of retinal toxicity.

The risk is relatively low at first, with a less than 1% chance after five years. Risk increases to 2% after 10 years and then jumps to 20% after 20 years. While we don’t fully understand the disease process, we know that Plaquenil impacts the metabolism of retinal cells, including photoreceptors.

It’s essential to screen your patients taking Plaquenil for new changes that could be associated with toxicity as any damage done is irreversible.  The American Academy of Ophthalmology (AAO) recommends screening with objective tests for retinal damage. This includes spectral-domain optical coherence tomography, fundus autofluorescence, and multifocal electroretinogram. If your patient is of Asian descent, we recommend wider visual field test patterns (24-2 or 30-2) as research indicates this demographic receives more damage that is peripheral.

Topiramate

This is an anti-seizure medication and a common treatment for migraines, bipolar disorder, PTSD, and OCD disorders. Topiramate can cause ciliary body effusion, which will relax zonules and contribute to lens thickening. The result could be a myopic shift of as much as -9.00D. It can also cause anterior rotation of the ciliary processes. Angle-closure often occurs in the first two weeks of taking the medication or within a few hours if doses are doubled.  

Using ultrasound biomicroscopy, and anterior segment OCT can reveal the anatomic changes that create this reaction. The good news is that most issues associated with Topiramate can be resolved by discontinuing the medication.  

Bisphosphonates

Prescribed to post-menopausal women, the drug Fosamax prevents calcium bone loss but can cause orbital inflammation, uveitis, and scleritis. While side effects aren’t common, they typically occur when first taking the drug. Side effects are reservable when drug use is stopped.

Minocycline

Commonly used to treat acne and often prescribed to teenagers. The drug can cause elevated intracranial pressure resulting in papilledema, which can lead to permanent vision loss if it’s not reversed. Some patients get headaches, others do not. 

These are just some of the side effects you should be looking out for as you screen your patients. The aging baby boomer demographic means that we’ll soon be seeing more patients on more medications, opening up the possibility of more ocular side effects. If you have any questions about the conditions you observe in your patients, please contact us directly. As a trusted Cohen Eye Institute partner, we’re here to help you with any of your eye care needs.