Ocular Side Effects of Common Medications: Downloadable Cheat Sheet

Aug 11, 2020
3 min read
🔥4.7k views

Download this gorgeous guide for need-to-know info on how common medications can affect the eyes!

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Familiarity with the ocular side effects of common medications is an important tool in patient assessment. Optometrists should be able to recognize and evaluate the etiology of patient complaints, some of which may be associated with systemic medications. Ocular findings such as blurry vision, double vision, or even a change in color vision may serve as a red flag throughout the examination.

This document is a visual tool grouping commonly used medications (and a few diseases) and their known ocular side effects. I have included popular mnemonics (and a few of my own) to help ease the pharmacology stress—let's call this your CHILL PILL.

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Get the illustrated cheat sheet!

Keep reading for the breakdown of effects from anterior to posterior!


Drugs affecting the cornea

Whorl keratopathy:

  • Mnemonic: “Mr. Fabry whorls his CHAI-T”
  • Fabry’s dz= lysosomal storage disease
  • Chloroquinolone
  • Hydroxychloroquine
  • Amiodarone
  • Indomethacin
  • Tamoxifen

Dry eye syndrome:

  • All meds with BAK
  • Azasite
  • Ganciclovir (Zirgan)
  • Bromfenac (Xibrom/Bromday)
  • Including glaucoma meds

SPK:

  • Accutane
  • Topical aminoglycosides
    • Tobramycin
    • Gentamycin
  • NSAIDs
  • ViropTic: d/t Thimersol preservative

Endothelial/DM pigmentation:

  • Chlorpromazine (anti-psychotic)
  • Thioridazine (anti-psychotic)
  • Promethazine (H1 blocker)

Stromal gold deposits:

  • Gold salts: visually asymptomatic yellow-brown deposits located in the posterior stroma and DM (ocular chrysiasis)

Delayed corneal healing:

  • Corticosteroids


Drugs affecting the sclera and uvea

Intraoperative floppy IRIS syndrome

  • Alpha 1 blockers
    • Tamsulosin (Flomax)

Blue sclera

  • Minocycline
  • Corticosteroids


Drugs affecting the lens

Anterior subcapsular effects

  • Mnemonic: "A+ the MCAT"
    • Think of the + as a shield: shield cataract in atopic dermatitis
  • Atopic dermatitis: Shield cataract
  • Miotics (vacuoles)
  • Chlorpromazine
  • Amiodarone (deposits)
  • Thioridazine

Posterior subcapsular cataracts:

  • Corticosteroids
    • Mnemonic: PSC = Corticol Steroid
    • Dose-dependent & irreversible
    • Hispanics at higher risk
  • Dx:
    • Retinitis pigmentosa
    • Gyrate atrophy
    • Myopic degeneration
    • Atopic dermatitis


Drugs affecting the conjunctiva and lids

Drug name/type Effect
Accutane
    Blepharoconjunctivitis
    Dryness
    Lid edema
NSAIDs and other blood thinners
    Subconjunctival heme
Sulfonamides
    Steven-Johnson syndrome
    Lid edema
Tetracyclines
    Pigmented cysts on conjunctiva
Sildenafil (Viagra)
    Subconjunctival hemorrhage
    Conjunctival hyperemia
Prostaglandins
    Conjunctival hyperemia
    Inc eyelash growth
    Inc pigment of periorbital skin & eyelashes
Tamiflu
    Conjunctivitis in 1% of patients


Drugs affecting EOMs

Nystagmus

  • Phenytoin
    • Mnemonic: PheNY-TWOin (Nystagmus and Diplopia)
  • Phenelzine
  • Phenobarbital
  • Diazepam
  • NSAIDs

Diplopia

  • Phenytoin
    • Mnemonic: PheNY-TWOin (Nystagmus and Diplopia)
  • Anti-depressents
  • Anti-psychotics
  • Anti-anxiety

Oculogryic crisis

  • Phenothiazines (Antipsychotics
    • Chlorpromazine
    • Thioridazine
  • Cetirizine (H1 blocker)

Smooth pursuits impaired

  • Alcohol


Drugs affecting the optic nerve

NAION

  • Mnemonic: "VIVA"
  • Viagra
  • Imitrex
  • Vardenafil
  • Amiodarone

Optic Neuritis

  • Mnemonic: "DICE"
  • Digoxin
  • Isoniazid
  • Chloramphenicol
  • Ethambutol

Pseudotumor Cerebri

  • Mnemonic: "NO CATS"
  • Nalidixic Acid
  • Oral Prednisolone
  • Contraceptives
  • Accutane/Vitamin A
  • Tetracyclines
  • Synthroid (in kids)

Drugs affecting the retina

Bull's Eye Maculopathy

  • Mnemonic: "Some People Can't Handle The Bull"
  • Dx:
    • Stargart's Disease
    • Progressive Cone Dystrophy
  • Chloroquine
  • Hydroxychloroquine
  • Thioridazine

Crystalline Deposits

  • Tamoxefen
    • Mnemonic: TamoxiFINE CRYSTALS

CME

  • Epinephrine


Drugs affecting color vision

  • Mnemonic: DAVE's color vision is affected
Drug name/type Effect
Digoxin
    Blue-yellow defect
    Entoptic phenomena (snowy/flickery vision)
Accutaners
    Affects color vision and may cause night blindness
Viagra
    Cyanopsia ("blue pill: blue-tinted vision")
Ethambutol
    Red/Green discrimination


Want the cheat sheet? Download it now!

What mnemonics do you use to remember drugs and their side effects? Share them in the comments!

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About Maria Martinez, OD

Dr. Maria Martinez is an optometrist currently completing her residency in ocular disease at Aran Eye Associates. She graduated from Nova Southeastern University College of Optometry in Fort Lauderdale, FL. Dr. Martinez sees a variety of patients in a busy OD/MD practice. She has a passion for helping patients understand the importance of vision and hopes to enhance eye care in minority communities. Outside of the exam room she showcases her balanced lifestyle of eye health, fashion, travel and her miniature goldendoodle, Maddox through her IG @EyeDocMaria. 


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