Eye HealthMedications Review

Ocular Side Effects: Topamax, Antidepressants, Viagra, Plaquenil, Prednisone

It’s well established that many common medications can cause eye and vision symptoms.  In this article we’ll be going through some of the ocular side effects of topamax, andidepressants, viagra, accutane, plaquenil, and prednisone.    It’s important that everyone taking these medications know the potential side effects.   Some symptoms may be mild, while others may be more serious and have greater long-term risks to vision and eye health.

Topamax

Topiramate, also known as Topamax, is a common medication used to treat migraines or seizure disorders. Rarely, Topamax can lead to topamaxprescription shifts and angle closure glaucoma. Prescription shifts would cause blurry vision. Angle closure glaucoma is when the angle between the dome-shaped front surface of the eye, called the cornea, and the flat colored, part of the eye, called the iris, becomes narrowed. This angle is where fluid is drained from the eye, keeping eye pressure at a normal level. When this angle becomes too narrow or completely closed, it causes a large increase in eye pressure. Symptoms of angle closure include blurry vision, severe eye pain, nausea or vomiting, and headache. These symptoms typically start between 3 to 21 days after starting Topamax. Although these side effects are rare, it is important to see your eye doctor immediately if you notice any changes in vision or experience severe eye pain.

Antihistamines and Antidepressants

Antidepressants and antihistamines are common medications that can exacerbate dry eye symptoms by decreasing tear production. Antihistamines are common over-the-counter drugs used for allergy relief and include Zyrtec, Allegra or Claritin. Dry eye symptoms include redness, tearing, and/or a burning gritty feeling. These symptoms may range from mild to severe, but can be quite bothersome if not treated. Dry eye has a wide variety of treatment options ranging from over the counter artificial tears and warm compresses to prescription medications. Antihistamines and antidepressants can also cause mild pupil dilation which puts patients with anatomically narrow angles at risk for angle closure. As said above, with any changes in vision or eye pain, please let us know.

Plaquenil

Hydroxychloroqine (Plaquenil) is used to treat autoimmune conditions such as rheumatoid arthritis and lupus. One of the most significant side effects of this medication is its ability to cause retinal toxicity leading to decreased vision. The retina can be thought of as the wall paper that lines the back of our eye. It is responsible for picking up the light that comes in and sending it to the optic nerve, which is similar to a large cable that connects our eye to the brain, allowing us to perceive what our eyes are seeing. Over time, Plaquenil can cause damage to retinal cells, particularly within the macula, where we get our most central vision. Although toxicity is rare, if you are taking this medication, it is recommended to get periodic screening done by your optometrist. At your appointment, your optometrist will perform a dilated exam and a visual field test to check for any changes. It is important to detect these changes early because they are not reversible once the medication is stopped.

Accutane

Isotretinoin, also known as Accutane, is another medication that can cause dry eye and rarely, can also cause changes to the optic nerve. Accutane is a common medication used for severe acne and its mechanism of action is to suppress sebum, or oil, production.  This not only targets the oil glands in the face, but also affects the oil glands in the eyelid – the meibomian glands. By altering meibomian gland function, there is a reduction in the oily component in tears, leading to increased tear evaporation and dryness. Rarely, you can also develop a condition called pseudotumor cerebri – bilateral swelling of the optic nerves secondary to increased intracranial pressure. Symptoms include severe headaches, vision loss, and nausea or vomiting. If these symptoms are experienced, see your doctor immediately. Pseudotumor cerebri will usually resolve after discontinuing of the medication.

Steroids

Oral steroids such a prednisone are used to treat a wide range of inflammatory disorders from rheumatoid arthritis to asthma. Side effects are seen with those on chronic steroid use. Studies show that long term or high doses of oral or inhaled steroids can lead to the development of cataract. Cataracts are generally thought of as something that develops in older individuals. However, with long term steroid use, you can develop cataracts at a much younger age. Symptoms of cataract include blurry vision, increased glare or halos around light, and reduced night vision. Luckily, cataracts are easily treatable with cataract surgery. Also, steroid use can increase eye pressure, leading to the development of glaucoma. Not everyone who is on steroids will have high eye pressure, but if you do, you are classified as a “steroid responder”. Luckily, when the steroid is discontinued, eye pressure will generally return to normal. If you are someone who is being chronically treated with steroids, it is important to schedule an exam to get evaluated.

Viagra

Sildenafil, also known as Viagra, is a common drug used among men for erectile dysfunction. However in high doses or in high risk individuals it can cause vision changes. A study conducted showed that out of 17 patients who were started on sildenafil at the highest dose of 100mg, 13 of these patients had disrupted color vision, including a “blue tint” to vision. Fortunately, this resolved after several weeks in all patients. An irreversible side effect that can occur is a form of optic neuropathy called non-arteritic anterior ischemic optic neuropathy (NAION). NAION affects the optic nerve and leads to sudden and severe vision loss. This occurs when there is lack of proper blood flow to the optic nerve. A common side effect of Viagra is systemic hypotension, or low blood pressure, rarely making patients susceptible to lack of blood flow to the nerve. Because of this, Viagra is contraindicated in those who have a history of past NAION. Your optometrist may also note that it should be used with caution if you have a small, or “crowded” optic nerve as that can increase the risk of NAION as well.

Topamax, antidepressants, Viagra, Plaquenil, and prednisone are just a few of the many commonly prescribed medications that can cause eye issues.  Whenever you start a new medication, make sure you read the labels to become aware of possible side effects. When in doubt, make an eye exam! Side effects are generally rare and can be managed, but if serious side effects occur – early diagnosis is key.

Dr. Becky Zaydel