Correspondence Address:
P Siva Reddy
Sarojini Devi Eye Hospital, Hyderabad (A.P.)
India

Full Text

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

8. Chlorpromazine

9. Chloromycetin sulfonamides etc.

10. Digitalis therapy

11. Barbiturates

12. Quinine

13. L. S. D.-25

14. Heavy metals

15. Oral Contraceptive drugs

16. Vitamin D

17. Vitamin A

Ocular effects

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

Cataract, Glaucoma

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

Diplopia, nystagmus

Migraine, retinal vascular disorders

Calcium deposits on the cornea and conjunctiva

1. increased intracranial pressure cerebral edema

2. papilloedema

3. exophthalmos

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

5. Sulfonamides

6. Isoniazide

7. Chloramphenicol

Drugs affecting the peripheral visual fields­

1. Organic arsenicals

2. quinine

3. Salicylic acid

4. Ergot

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.