Most medications have side effects in different organ systems of the body, which includes the eyes. In this section we will try to briefly elaborate on important side effects of commonly used medications in the eyes. This section will be an evolving one, due to the fact that new medications are constantly coming into medical practice and prescribed for the patients.

STEROIDS These are a group of natural or synthetic hormones with a variety of properties and mechanisms of action. They are utilized as medications to achieve different desirable effects in order to combat certain diseases. Whether steroids are used orally, injected or topically as eye drops / nasal spray, they can give rise to some important side effects in the eyes. These side effects can ultimately threaten the vision , such as development of cataracts and steroid-induced glaucoma. These effects can be reversible if they are caught in time. For these side effects to occur patient has to be on systemic steroids rather long time yet they can occur sooner when used in the form of eye drops. Example of the diseases that steroids are used as medication include Asthma, lupus, arthritis , ulcerative colitis , vernal conjunctivitis, uveitis ,etc.

ANTI – MALARIA DRUG, CHLOROQUINE This medication is used for the treatment of lupus and rheumatoid arthritis. With high dosage and long duration of treatment, it can cause pigment accumulation in and damage to the macular cells, and will result in blurry vision. In the full blown effect of the medication on the macula, it will look like a bull’s eye, which can be detected by eye doctors. If these changes are detected early , they are reversible, but with the patient bi-annually to an eye physician to check the vision, especially the color vision and the macula for evaluation of any damaging effects of chloroquine.

AMIODARONE (CORDARONE) This medication is used to control irregular heart beats. Patients taking this medication for about 6-8 weeks will have brownish deposits of the drug in the superficial layers of their corneas which will give rise to some blurry vision , glare or halos around lights. .Usually the amount of deposit and vision problem is minimal and there is no need to discontinue the medication. In most these cases the heart problem is so important that the cardiologist will prefer to keep the patient on the medication in spite of minimal vision compromise. In any case the cardiologist should be informed of the presence of deposits and visual disturbance.Gold which is sometimes used in lupus and rheumatoid arthritis can also deposits on the surface of cornea. Other medications such as , , , can deposit on the cornea. Drugs affecting the retina Phenothiazine groups of medications that are used in psychiatry, such as Chlorpromazine and thioridazine for many years will have retinal side effects. Tamoxifen used in some breast cancer patients can have retinal side effects in the form of deposits , macular edema and bleed and optic nerve inflammation.

Interferon which is used some cancer disorders and hepatitis, can cause retinal side effects , but these effects are reversible.

Anti-inflammatory (non-steroidal) agents , can cause retinal degeneration, color vision problem which are all reversible after cessation of medication . These agents can also cause swelling of optic nerve( seeing nerve) ,pseudotoumor of brail(a condition that simulates as a brain toumor but actually it is not a toumor at all ) . Used as a vitamin in supplements, and as anti-triglyceride causes transient blurring of vision after taking the medication, cystic edema of the macula with high doses ( over 1 gr/day ) and is reversible.

Drugs affecting optic nerve ( the seeing nerve).

Anti- T.B. medications, Isoniazid ( usually Vit B6 is given to patient to decrease toxic effect of isoniazid) , Ethambutol ,. Birth control pills, Viagra ( can cause eye stroke). both can cause color vision problem and optic neuropathy

Drugs affecting brain

Cyclosporine an anti-metabolite is used in transplant patient to prevent rejection. This medication may increase intracranial pressure ( causing headache) and optic nerve edema..Several medications can cause a condition called pseudo-tumor cerebri in which there is no tumor in the brain but it mimics like one, and headache, edema of optic nerve, high intra-cranial pressure, are some of its manifestations.