Case reports of drug induced ocular toxicity
| Author (year) | Drug | Adverse reaction | Population | Intervention and outcome | Comments |
|---|---|---|---|---|---|
| Miller13 (1978) | Chlorothiazide | Oculomotor nerve palsy | 47 year old male. GTT abnormal on thiazide treatment | 7 months of diuretic for nephrolithiasis. 3 days' history of orbital pain and ptosis. Diuretic stopped, 3/12 later, palsy resolved and 2 GTTS were normal | No rechallenge but all other causes of palsy ruled out. Proposed mechanism of glucose intolerance induced microangiopathy |
| Sponsel14 (1992) | Indapamide | Bilateral cataracts | 39 year old male. Hypertensive and obese | 3½ years of indapamide. Hyperglycaemia with reduced visual acuity and colour vision changes. Stopping therapy halted progression of visual disturbances | No rechallenge but no other risk factors for cataracts. Surgery required for cataracts |
| Wymore15(1982) | Chlorpropamide | Optic neuropathy | 65 year old male. NIDDM for 1 year | Reduced visual acuity after 1 year of treatment. Dramatic improvement in visual acuity and colour vision on stopping drug | Rechallenge for 5 days showed reduced visual acuity. Vision returned to baseline after stopping |
| D'Arcy16(1989) | Glibenclamide | Myopia | 35 year old male | Symptomatic after 2 days of glibenclamide. Vision returned to normal 3 days after discontinuation | No rechallenge. Patient remained on diet control for diabetes |
| Lightman17 (1989) | Glyburide (Glibenclamide) | (1) Hyperopia (2) crystalline lens deposits | 66 year old male. New case of NIDDM | Osmotic effects thought to be cause of lens changes | No rechallenge. Alternative explanation proposed by Keller45 |
| Hamill18(1983) | Scopolamine (Transdermal) | Acute angle closure glaucoma | 58 year male. NIDDM and hypertensive on methyl dopa and propranolol | Intraocular pressure >80 mm Hg after 4 days of patch treatment. Probably unrelated to diabetes | No rechallenge. Predictable from pharmacology |
| Sedwick19(1992) | Amiodarone | Optic neuropathy | 62 year old male. Hypertensive with NIDDM on diazide and glyburide | Sudden visual loss when given amiodarone. Bilateral optic neuropathy | Vision improved after stopping amiodarone. After 3 weeks of rechallenge, vision deteriorated |
| Zenimaru20(1997) | Interferon | Worsening of retinopathy | 38 year old male. Diabetic with hepatitis C | Development of retinopathy with massive vitreous haemorrhages after 9 months | Vitreous haemorrhage required surgery. No rechallenge |
| Dukar26(1993) | OKT3 | Retinal toxicity | Two post-renal transplant females. One had IDDM | Case 1: reduced visual acuity after 1 week of OKT3. Cataract extraction 2 years later. Repeat OKT3 resulted in vision loss. Case2: OKT3 for kidney rejection resulted in total loss in vision after 2nd dose | Rechallenge in case 1. No other reason for vision loss apart from slight narrowing of retinal vessels |
| Flipovic21(1997) | Ethambutol | Optic neuropathy | Series of cases | Few details available | |
| Sorensen22 (1977) | Phenformin + ethanol | Retinal dysfunction | 57 year female. Diabetic and obese. Following alcohol binge | Severe reduction in visual acuity. Blindness improved with intensive treatment for lactic acidosis | No rechallenge. Possible mechanism is inhibition of oxidative metabolism |
| Maddox23 (1977) | Warfarin | Retinal and vitreous haemorrhages | Female diabetic underwent mitral valvotomy | Given warfarin 11 mg. After 1 year haemorrhaged into both eyes resulting in blindness | No recovery. No rechallenge |
| Caramelli24(1991) | Streptokinase | Retinal and vitreous haemorrhage | 46 year old diabetic male with 3 years proliferative retinopathy. Given streptokinase for MI | Marked reduction in vision with some recovery. Cardiac status felt to have benefited from thrombolysis | No rechallenge. Vision improved without further treatment |
| Jimenez-Lucho25 (1987) | Isoniazid | Optic neuropathy | 71 year old. Also on ethambutol, pyridoxine, nifedipine, and allopurinol | Reduced visual acuity after 7 months of TB treatment. Greatest improvement after stopping isoniazid. | No rechallenge |
↵Indicates data obtained from abstract.