Year : 1982 | Volume
: 30 | Issue : 4 | Page : 261--262
Toxic effects of locally administered drugs and ocular side effects of drugs following systemic administration
P Siva Reddy
Sarojini Devi Eye Hospital, Hyderabad, India
P Siva Reddy
Sarojini Devi Eye Hospital, Hyderabad (A.P.)
|How to cite this article:|
Reddy P S. Toxic effects of locally administered drugs and ocular side effects of drugs following systemic administration.Indian J Ophthalmol 1982;30:261-262
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Reddy P S. Toxic effects of locally administered drugs and ocular side effects of drugs following systemic administration. Indian J Ophthalmol [serial online] 1982 [cited 2020 Apr 10 ];30:261-262
Available from: http://www.ijo.in/text.asp?1982/30/4/261/29444
In day to day practice of treating the Ophthalmic patients, we have drugs both for local application into the eye, and systemic administration resulting in ocular side effects. For local drug therapy into the eye, we have topical solutions, ointments, eye pledgets, iontophoresis, subconjunctival injections, retrobulbar injections, peri-ocular injections, intracameral and intravitreal injections, and medically drug soaked hydrophilic contact lenses and irritations into the eye. We know that the orbital structures, eye lids, and the structures of the eye like uvea, are highly vascular and so any drug given systemically, can easily reach these structures in good concentration provided the drug has a lipid soluble property which can penetrate through the blood aqueous barrier.
The two major types of hazards are.
(a) Drug hypersensitivity
(b) Toxic reactions
By definition, a hypersensitivity reaction is restricted to an unexpected response of the patient to a drug whereas toxic reaction includes a variety of undesirable effects of a drug.
Side effects of local treatment
(i) "contact dermatitis" - eg. atropine pencillin, Neomycin etc.
(ii) Follicular Hypertrophy of the Conjunctiva eg. Eserine, pilocarpine
(iii) pigmentation of the conjunctiva eg. Argyrosis, epinephrine
(iv) Corneal epithelial damaged local anaesthetics like Anethane drops,l0% phenylephrine etc.
(v) Iris nodular hypertrophy and cystic degeneration
1. D. F P.
2. Echothiophate iodide used for squint
(vi) Occlusion of lacrimal puncta eg. long term eserine therapy D. F. P. pilocarpine, epinephrine
There may be systemic absorption of topically applied drug by way of absorption through mucous membranes eg. 1. "Atropine" application into the eyes producing systemic flush and hyperpyrexia in babies. 2. Phenylephrine therapy producing Tachycardia 3. Prostigmine therapy may produce nausea, vomiting sweating etc. 4. Topical corticosteroids such as Dexamethasone, and betamethasone if used for prolonged time can produce local oculur effects like steroid induced glaucoma, subcapsular cataractous changes in the lens and mycotic keratitis.
Ocular complications of systemically admini stered drugs
Name of the drug
1. Belladonna, atropine like drugs
2. Chloroquine (antimalarial)
3. Gold therapy (arthritis drug)
4. Indocid (Analgesic)
5. Acetazolamide (diamox)
6. Systemic corticosteroids
7. Tranquilizers eg. Anatensol
9. Chloromycetin sulfonamides etc.
10. Digitalis therapy
13. L. S. D.-25
14. Heavy metals
15. Oral Contraceptive drugs
16. Vitamin D
17. Vitamin A
Mydriasis & cycloplegia
Corneal epithelial edema; opacities of Cornea retinal edema and pigmentation optic atrophy.
Pigmentation of the cornea
Corneal opacities Macular pigmentation
Transient loss of accommodation
Oculogyric crises, blurred vision
Pigmentation of the bulbar Conjunctiva, cornea,
opacities of the lens and anterior stellate Cataract
Optic neuritis Opticatrophy
Transient visual loss xanthopsia, scotomas
Diplopia, blurred vision
Scotomata, loss of vision
Color and form hallucinations
Migraine, retinal vascular disorders
Calcium deposits on the cornea and conjunctiva
1. increased intracranial pressure cerebral edema
4. retinal edema
5. pigmentation of lids
6. retinal hemorrhages
We know that many drugs can cause disorders of the colour visual fields.
1 . ethyl alcohol
2. Methyl alcohol
3. Carbon Di sulphide
4. Sedatives like gardinal
Drugs affecting the peripheral visual fields
1. Organic arsenicals
3. Salicylic acid
Ocular effects of oral contraceptives
1. Peripheral Neuropathy
2. Blurred vision
3. Muscae volitantes
4. Retinal edema
5. Lenticular Capsular edema etc.
6. Macular edem etc.
Concluding any drug either given locally or Systemically can produce side effects in a major degree provided its usage is for a considerable long duration.