OCULAR SIDE EFFECTS OF MEDICATIONS
This page discusses interactions of drugs with the eyes and the vision. This is not intended to be a complete catalog of all possible ocular side effects from different medications. Instead, it lists common ocular side effects, or those which deserve special mention. Just because a drug is not listed here does not mean that it does not have any possible ocular side effects. Included are over-the-counter medications and prescription medications. Eye medications are not included here.
Read this important information before proceeding further:
These sections are not intended to replace the professional examination and diagnosis by a physician, and they are presented here purely for informational purposes. All possible diagnoses and treatment options are not covered, and the information discussed should not be taken as a recommendation to self-diagnose and self-treat a condition. A misdiagnosed or improperly treated eye condition can result in a permanent loss of vision, or a permanent loss of function of the eye or visual system. In the case of any eye problem, seek medical attention promptly. This can include emergency room treatment, as well as treatment by a medical physician or eye care provider.
Medications Discussed Include: tamsulosin (Flomax ), Dutasteride (Avodart), Finasteride (Propecia - also used for male pattern baldness), Terazosin (Hytrin), Doxazosin (Cardura), Alfuzosin (Uroxatral), Saw Palmetto (herbal)
Alpha-blocker medications, and primarily tamsulosin (Flomax) have been associated with a condition which can occur during cataract surgery known as Intraoperative Floppy Iris Syndrome (IFIS). While any of the medications in the above list can be associated with IFIS, including the herbal medication Saw Palmetto, Flomax has the highest risk. In this condition, the smooth muscle dilator of the iris becomes affected, and the pupil will often not dilate well. During cataract surgery, the pupil will often spontaneously undilate making surgery progressively more difficult to perform. Iris billowing and prolapse through incision openings further complicate the surgery. IFIS can greatly increase operative time during cataract surgery and has been associated with increased risk of capsular rupture.
Unfortunately, stopping medications such as Flomax preoperatively has not been effective at preventing IFIS, which can still occur even years after stopping the medication. Both men and women are using this type of medication for a variety of indications. However, if the operating surgeon is aware of the history of Flomax use (and other medications above), steps can be taken to minimize the risk or extent of IFIS during the surgery, and thus prevent complications. The problem prompted ophthalmic organizations to initiate educational efforts towards members of the American College of Physicians and the American Academy of Family Practice. The educational update stated:“In a patient with a known diagnosis of cataract, prescribing physicians may wish to consider involving the patient's cataract surgeon prior to initiating non-emergent, chronic tamsulosin or alpha blocker treatment. Options might include an eye exam or having either the patient or the prescribing MD communicate with the cataract surgeon. Patients should also be encouraged to report any prior or current history of alpha-1 antagonist use to their ophthalmic surgeon prior to undergoing any eye surgery
Medications Discussed Include: There are a large number of medications with anticholinergic properties, some of which overlap which other medications listed on this page:
Antihistamines: Chlorpheniramine, Hydroxyzine, Meclizine, Promethazine Antipsychotics: Chlorpromazine, Clozapine, Thioridazine Antispasmodics: Dicyclomine (Bentyl), Hyoscyamine, Oxybutynin Cyclic antidepressants: Amitriptyline, Clomipramine, Desipramine, Doxepin, Imipramine, Nortriptyline Mydriatics: Cyclopentolate, Homatropine, Tropicamide
Generally, these medications have ocular side effects of dry eye and dry mouth, pupillary dilation, and decreased accommodation (focusing ability). The focusing impairment may be especially bothersome in younger patients taking these medications. In susceptible individuals, anticholinergics can increase the risk of or worsen angle closure glaucoma.