Adverse ocular reactions possibly associated with isotretinoin

A total of 261 adverse ocular reactions occurred in 237 patients who received isotretinoin, a commonly used drug in the treatment of severe cystic acne. Blepharoconjunctivitis, subjective complaints of dry eyes, blurred vision, contact lens intolerance, and photodermatitis are reversible side effects. More serious ocular adverse reactions include papilledema, pseudotumor cerebri, and white or gray subepithelial corneal opacities; all of these are reversible if the drug is discontinued. Reported cases of decreased dark adaptation are under investigation. Isotretinoin is contraindicated in pregnancy because of the many reported congenital abnormalities after maternal use (including microphthalmos, orbital hypertelorism, and optic nerve hypoplasia).     

Adverse ocular effects of flecainide

PURPOSE: To study if flecainide has ocular adverse effects. METHODS: Both eyes of 38 flecainide medicated patients were thoroughly examined including colour vision, contrast sensitivity and visual fields. RESULTS: 10.5% of the patients had blurred vision on lateral gaze lasting for a couple of seconds. Small corneal deposits were found in 14.5% of the patients. All visual function tests were normal. CONCLUSION: Flecainide seems to be a safe drug with minimal ocular adverse effects.     

Adverse external ocular effects of topical ophthalmic medications

Medical and pharmacologic research of recent years has led to the development of many potent and efficacious topical ophthalmic medications. Unfortunately, many of these drugs are potentially toxic or allergenic, and their adverse effects have themselves become important external ocular diseases. This paper presents a classification of these adverse effects and provides a review of their etiology, pathogenesis, histopathology, diagnosis, and management. It is hoped that this information will be helpful to ophthalmologists in their efforts to anticipate, prevent, recognize, and treat drug-induced ocular problems and that it will serve to emphasize the importance of avoiding the ill-considered use of medications.     

Adverse reactions to topical ocular anesthetics.

The purpose of this article is to clarify some of the misunderstanding about adverse reactions to topical ocular anesthetics. Discussion will include: types of adverse reactions that are theoretically and practically possible; advice on handling the reactions that can occur; and precautions for minimizing their occurrence.     

Adverse effects of beta-blocker eye drops on the ocular surface

PURPOSE: We investigated the adverse effects of beta-blocker eye drops on tears and ocular surface epithelium. METHODS: We studied twenty-three eyes of twenty three glaucoma patients [10 males, 13 females: 53.8 +/- 12.2 (yrs; mean +/- standard deviation)] treated with beta-blocker eye drops for more than three months and thirty two control subjects (16 males, 16 females: 50.4 +/- 10.9). The parameters described below were compared between the groups: 1. the radius of tear meniscus curvature, 2. grades for tear lipid layer interference patterns, 3. non-invasive breakup time (N-BUT), 4. cotton thread value, 5. scores of fluorescein staining, 6. fluorescein breakup time (F-BUT), 7. scores of rose bengal staining, 8. and Schirmer I value. RESULTS: The glaucoma group showed a significant decrease in the radius of tear meniscus curvature (p = 0.0007), a significantly lower distribution in the grades for tear lipid layer interference patterns (p = 0.0270), a significant difference in the scores of fluorescein staining (p < 0.0001), a significant shortening in F-BUT (p = 0.0050), a significantly higher distribution in the scores of rose Bengal staining (p = 0.0010), and a significantly smaller value in Schirmer I value (p = 0.0042). However, there was no significant difference in N-BUT and cotton thread value. CONCLUSIONS: These results clearly demonstrate that the ocular surface in glaucoma patients treated with beta-blocker eye drops show dry-eye-like changes in terms of tears and ocular surface epithelium.     

Adverse effects of topical antiglaucoma drugs on the ocular surface

Purpose : This study was designed to determine the effect of long‐term antiglaucoma topical medication on the ocular surface; measuring basal Schirmer’s and tear break‐up time tests using conjunctival impression cytology. Methods : The ocular surfaces of 30 control subjects (group 1), 24 primary open‐angle glaucoma patients treated with 0.5% betaxolol hydrochloride (group 2), 27 primary open‐angle glaucoma patients treated with 0.5% timolol maleate (group 3) and 26 primary open‐angle glaucoma patients treated with 0.5% betaxolol and 1% dipivefrin hydrochloride (group 4) were evaluated. Basal Schirmer’s and tear break‐up time tests were measured and ocular surface changes were determined by impression cytology. Impression cytology specimens of each group were graded and scored in the range 0–3 according to Nelson’s method. Results : Patients in groups 2, 3 and 4 showed statistically significant fewer normal basal Schirmer’s tests (wettability) and tear break‐up time tests (P < 0.01). Also, the conjunctival impression cytology scores were significantly higher in groups 2, 3 and 4 than in group 1 (P < 0.01). Conclusions : The conclusion was that it is possible that conjunctival surface and tear film function change after the long‐term use of antiglaucoma medication.     

Scleritis and other ocular side effects associated with pamidronate disodium

PURPOSE: To evaluate reported cases of scleritis and other ocular side effects associated with pamidronate disodium, with emphasis on previously unreported cases of scleritis.DESIGN: Observational case series. METHODS: Case reports from the National Registry of Drug-Induced Ocular Side Effects (Casey Eye Institute), the Food and Drug Administration, the World Health Organization, and the literature were reviewed to determine possible adverse ocular side effects associated with pamidronate disodium. The World Health Organization's Causality Assessment Guide was used to categorize an adverse drug reaction. RESULTS: Seventeen cases of unilateral scleritis and one case of bilateral scleritis occurred, usually within 6 hours to 2 days after intravenous pamidronate disodium. Six patients had positive rechallenge testing with the scleritis occurring after a repeat drug exposure. Other ocular side effects with positive rechallenge data, associated with pamidronate disodium, include blurred vision, nonspecific conjunctivitis, ocular pain, bilateral anterior uveitis, and episcleritis. CONCLUSIONS: This is the first report, with rechallenge data, of any drug causing scleritis. Pamidronate disodium can cause vision-threatening diseases, which may require discontinuing the drug in some uveitis cases and, in this series, all cases of scleritis.     

Adverse systemic effects from pledgets of topical ocular phenylephrine 10%

PURPOSE: To report 11 cases of adverse systemic reactions to topical ocular application of phenylephrine 10% in pledget form and to discourage this method of treatment for hemostasis in laser assisted in-situ keratomileusis (LASIK) surgery and other ophthalmic uses.DESIGN: Observational case series.METHODS: The literature, reports provided to the spontaneous reporting system of the United States Food and Drug Administration and the National Registry of Drug-Induced Ocular Side Effects (Casey Eye Institute, Portland, Oregon) were reviewed. Age, sex, duration of therapy, other drugs the patient was taking, and systemic reactions are provided in the series of 11 cases with adverse systemic reactions.RESULTS: Eleven cases of adverse systemic reactions to topical ocular phenylephrine 10% applied in pledget form occurred in 8 male and 3 female patients with an age range from 1 to 76 years. All cases occurred after a single exposure, most patients noted systemic effects within minutes of phenylephrine application, and the adverse systemic reactions included severe hypertension, pulmonary edema, cardiac arrhythmia, cardiac arrest, and subarachnoid hemorrhage.CONCLUSIONS: We recommend ophthalmologists not use this method of phenylephrine application and believe it is contraindicated in ophthalmic surgery, especially when other medications may be used.     

Chronic keratoconjunctivitis associated with ocular adenovirus infection.

Adenovirus (types 3, 4, 5) was implicated as the etiologic agent in three cases of persistent keratoconjunctivitis. In two, virus was isolated 25 and 29 months after the onset of symptoms; the third patient has suffered intermittent flares of kerato-conjunctivitis since the initial isolation of virus 13 weeks after the onset of the disease. Such patients may represent a previously unsuspected source of adenovirus in the population. All were given corticosteroids topically. This treatment may have prolonged the adenoviral disease.     

Compliance with ocular therapy

Patient noncompliance with the physician's prescribed therapeutic regimen can present serious obstacles both to individual patient care and to the obtaining of information necessary for controlled drug trials. Unfortunately, the physician often is unable to determine whether and to what extent a patient is not complying with therapy. This article reviews the problem of patient noncompliance with particular emphasis on how and why noncompliance occurs, and methods of predicting, detecting and coping with the defaulting patient.     

Exogenous ocular candidiasis associated with intravenous heroin abuse.

Seven young men developed disseminated candidiasis within 10 days of a single episode of intravenous heroin abuse. Sequential development of eye and skin lesions was noted in all cases. The bone or costal cartilage was involved in five. Ocular manifestations of candidiasis included episcleritis, chorioretinitis, and endophthalmitis. A presumptive diagnosis of candida chorioretinitis was established rapidly by culture of Candida albicans from involved skin and costal cartilage. Systemic therapy with amphotericin B plus 5-fluorocytosine resulted in cure of the episcleritis, chorioretinitis, osteomyelitis, costochondritis, and skin infection. Pars plana vitrectomy with local instillation of amphotericin B was required to cure chorioretinitis associated with vitreal extension of infection.     

Cystoid macular edema associated with latanoprost therapy in a case series of patients with glaucoma and ocular hypertension.

OBJECTIVE: To identify coexisting ocular diagnoses in a case series of eyes that developed cystoid macular edema (CME) associated with latanoprost therapy. DESIGN: Retrospective observational case series. PARTICIPANTS: Seven eyes of seven patients who developed CME possibly associated with latanoprost treatment were studied. INTERVENTION: When these patients, all of whom were treated with latanoprost in addition to other glaucoma medications, described blurred vision or eye irritation, ocular examination revealed CME, which was confirmed by fluorescein angiography. Latanoprost was discontinued, and in three cases topical corticosteroids and nonsteroidal anti-inflammatory agents were used to treat the CME. MAIN OUTCOME MEASURES: Visual acuity and intraocular pressure were determined before latanoprost use began, during therapy, and after latanoprost use ceased. In these cases, resolution of CME was documented clinically after discontinuing latanoprost. RESULTS: Clinically significant CME developed after 1 to 11 months of latanoprost treatment, with an average decrease of 3 lines in Snellen visual acuity. Intraocular pressure decreased an average of 27.9% during treatment. Cystoid macular edema was confirmed in all cases by fluorescein angiography. In these seven patients, the following coexisting ocular conditions may have placed these eyes at risk for prostaglandin-mediated blood-retinal barrier vascular insufficiency: history of dipivefrin-associated CME, epiretinal membrane, complicated cataract surgery, history of macular edema associated with branch retinal vein occlusion, history of anterior uveitis, and diabetes mellitus. In all cases, the macular edema resolved following discontinuation of latanoprost, in some instances with concomitant use of steroidal and nonsteroidal anti-inflammatory agents. CONCLUSIONS: In this case series of pseudophakic, aphakic, or phakic eyes, the temporal relationships between the use of latanoprost and developing CME, and the resolution of CME following cessation of the drug, suggest an association between latanoprost and CME. In all cases, coexisting ocular conditions associated with an altered blood-retinal barrier were present.     

Management of traumatic cyclodialysis cleft associated with ocular hypotony.

BACKGROUND AND OBJECTIVE: To evaluate the efficacy of direct cyclopexy for treatment of traumatic cyclodialysis cleft associated with ocular hypotony. PATIENTS AND METHODS: Eyes with traumatic cyclodialysis cleft were treated with direct cyclopexy or 1.0% atropine eyedrop. RESULTS: Five eyes with a large cyclodialysis cleft were treated with direct cyclopexy. Postoperatively, these eyes obtained normal intraocular pressure. Four of the 5 eyes had good visual acuity, and 1 eye that had preoperative subretinal hemorrhage in the macula had poor visual acuity. Of the 3 eyes treated with 1.0% atropine eyedrops, 1 had good visual acuity, and 2 with retinal folds had fairly good and poor visual acuity. CONCLUSION: The present study showed that direct cyclopexy is useful for the treatment of traumatic cyclodialysis cleft associated with ocular hypotony, and that the cyclodialysis should be surgically treated before irreversible retinal folds develop.