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28 Cards in this Set
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- Back
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Anti-cholinergic affects-
decreased accomodation. dry eye, ASC cataract, corneal endo pigment deposits, macular pigment changes (the visual threat) |
Phenothiazines
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The phenothiazines mentioned
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chlorpromazine (thorazine), thioridazine (mellaril)
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half life up to 100 days, can cause bilateral optic nerve edema in some changes, VA changes can recover with d/c but VF often don't
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Amiodarone - cardarone, pacerone
r/o fabry's |
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haloes, color changes rarely va decrease, optic neuritis
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Digoxin
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Risks for ocular damage include…….
Low body weight / daily dose over 6.5 mg/kg OR obesity with high dose Renal or hepatic dysfunction Extended duration of therapy Lifetime dose over 200g |
plaquenil
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plaquenil TX?
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Visual acuity
Central visual field analysis with 10-2 Dilated evaluation of macula Baseline fundus photo before treatment may be useful Multifocal ERG (very sensitive!), SD-OCT (Flying Saucer sign), FAF when VF defects occur. Take any VF defect very seriously, and repeat the test Report to rheumatologist Discontinue when possible at earliest sign of trouble (remember can progress after d/c) |
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Nystagmus and color disturbances are relatively common and are dose related
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Dilantin (Phenytoin)
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SE can include acute, bilateral angle closure
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Topamax (Topirimate)
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what's topamax used for?
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Anticonvulsant used for migraines, epilepsy, depression, bipolar disease and weight loss
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why can topamax cause acute angle closure? when does it occur?
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within 2 weeks. happens because Severe edema of the ciliary body leads to angle closure, excessive myopic shift and even uveal effusion
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TX for acute angle closure with Topamax?
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LPI won't work! steroids and cyclopleges.
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causes a 10 micron increase in RNFL thickness on average with OCT
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topamax
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Biphosphonate
Used to treat osteoporosis, rarely Paget’s disease and bone metastases |
fosamax
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can cause scleritis!
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fosamax
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Vortex keratopathy
Macular edema with decreased vision Leads to decreased optic cup volume secondary to astrocyte swelling |
and crystalline maculopathy-
Tamoxifen |
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Tanning agent that can cause retinal changes.
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canthaxanthine
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Dry eyes / meibomian gland dysfunction
Conjunctivitis Decreased night vision |
Isoretinoine (Accutane)
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Phosphodiesterase 5 inhibitors
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Viagra / Levitra / Cialis
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Changes in color perception are common, many colors possible
Increased light sensitivity, photopsia Dose dependent |
Viagra Etc those taking 200mg of Viagra have 50% chance of ocular side effects; 50 mg <5 % (normal dose)
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Many reports of NAION within 24-36 hours of taking these drugs (around 50 cases)
All individuals involved had a “disc at risk” and vascular risk factors for NAION Common to have these vascular problems in those suffering from ED 10 X risk with history of myocardial infarction; 7X risk with hypertension |
Viagra
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Mechanisn of viagra?
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Stimulates nitrous oxide leading to hypotension
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Affects PDE 6 in the retina so has many of the same ocular side effects as Viagra etc. Antifungal drug
Color vision changes / photophobia / blurred vision 30 minutes after dose No link to NAION |
Voriconazole (Vfend)
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Treatment used mainly for hepatitis.
Very long treatment course Can cause retinal CWS and other vascular retinopathy / macular edema Can be sight threatening but rarely is Most common is CWS near the optic nerve |
Pegulated Interferons
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What to look out of CWS?
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think undiagnosed cancer! Also remember HIV and GCA
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Prostate therapy (Alpha 1 blocker)
Also affects iris dilator muscle IFIS ( Intraoperative Floppy Iris Syndrome) Leads to progressive miosis with floppy iris during intraocular surgery. Makes cataract surgery quite challenging! |
Flomax
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New medication (silodosin) for BPH that is also highly selective for Alpha 1A receptors
Same risk for IFIS as Flomax |
Rapaflo
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corneal edema SE
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amantadine
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SE macular edema
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Fingolimid
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