Ocular changes may be of minor importance with no apparent adverse sequelae. Iris color change secondary to latanaprost therapy or mild mydriasis due to antidepressant medications are of this nature. Conversely, toxic ocular reactions, such as glaucoma from corticosteroid therapy, retinopathy of chloroquine therapy, or optic neuropathy of ethambutol therapy, may threaten sight. Ocular toxicity may also be part of a more widespread toxic reaction. Examples of this include Stevens-Johnson syndrome from a wide variety of drugs and fetal alcohol syndrome seen in offspring of alcoholic mothers. In certain cases, it may be useful to make use of mild toxic ocular reactions as an indicator of more serious systemic toxicity, such as abnormal color vision seen with digitalis toxicity.

The onset of a drug-induced ocular event may be within minutes or may ake years, such as systemic hypertension occurring within 10 to 20 minutes after topical use of ocular 10% phenylephrine or permanent ocular sicca after years of oral isotretinoin use. The adverse ocular event may be dose dependent, as with phenothiazine or hydroxychloroquine. The reaction can be reversible, as with corneal deposits from amiodarone, or irreversible, as with amiodarone neuropathy. Other reactions may be idiosyncratic, such as aplastic anemia due to topical ocular chloramphenicol or optic neuritis due to ibuprofen.

This chapter reviews toxic effects of topical ocular therapy and ocular toxicity of systemic drugs. The list of adverse effects is not comprehensive and our intent is to provide information on adverse drug effects of medications commonly used by ophthalmologists. Much of the data collected here come from the National Registry of Drug-Induced Ocular Side Effects, a clearinghouse for drug information on adverse ocular effects. Health care professionals suspecting a possible drug-induced ocular change are encouraged to send reports to the Registry. Cases of greatest interest include previously unsuspected, rare, severe, or unusual drug-related ocular side-effects. Data can be forwarded to F.T. Fraunfelder, MD, Casey Eye Institute, Oregon Health Sciences University, 3375 SW Terwilliger Boulevard, Portland, OR 97201; fax: (503) 494–4286.

TABLE 1. Adverse Oadar Reactions of Drugs

TABLE 2. Adverse Systemic Reactions of Drugs Commonly Used in Ophthabnology

TABLE 3. Agents Affecting Specific Ocular Areas

TABLE 4. Visual Tests Helpful in Monitoring for Ocular Drug Toxicity

Dukes MNG, ed. Meyler's Side Effects of Drugs. 11th ed. Amsterdam: Excerpta Medica, 1988

Fraunfelder FT, Fraunfelder FW. Drug-Induced Ocular Side Effects. 5th ed. Woburn, MA: Butterworth-Heinemann, 2001

Grant WM. Toxicology of the Eye. 4th ed. Springfield, IL: Charles C Thomas, 1993