Table 3.
Medications with ocular toxicities
| Drug | Ocular toxicity | Frequency | Management and prevention recommendation |
Strength |
|---|---|---|---|---|
| Cytosine arabinoside | Keratoconjunctivitis98 | Common | Prophylactic glucocorticoid eye drops,98 2-deoxycytidine eye drops applied prior to therapy98 | A-II |
| Ocular pain, tearing, foreign body sensation, photophobia, epiphora, blurred vision with evidence of bilateral conjunctival hyperemia and fine corneal punctate opacities98 | Occasional | Eye washing with physiologic saline, 0.1% sodium betamethasone eye drops applied prior to therapy | B-III | |
| Imatinib | Peri-orbital edema, sometimes leading to visual obstruction99 | Common | Warm compress | A-III |
| Corticosteroids (systemic) | Cataracts,13, 14, 85 increased IOP, glaucoma66, 68, 69 | Common | Limit use | A-III |
| Screening for cataracts and glaucoma | C-III | |||
| Corticosteroids (topical) | Increased IOP, glaucomatous optic atrophy, visual field defects, cataracts, infectious keratitis | Occasional to rare | Monitor IOP within 1 month of initiating treatment, restrict extended use of high potency steroids | A-III |
| Regular screening for cataracts, surgery as needed18 | B-III | |||
| Discontinue steroids,66 topical aqueous humor suppressants,71, 72 trabeculectomy73 | A-I | |||
| Cyclosporine (systemic) | Microvascular retinopathy60 | Rare | Improve with drug discontinuation60 | A-II |
| Cyclosporine (topical) | Redness, stinging, burning | Occasional | Lubricating drops,88 chill bottle87 before instilling cyclosporine | A-II |
| Tacrolimus (topical) | Burning sensation | Common | Symptoms typically improve in 1 month after drug discontinuation.86 | A-II |
| Phenothiazines(chlorpromazine, thioridazine) | Abnormal pigmentation of the eyelids, interpalpebral conjunctiva and cornea with long-term use94 | Common | Improve with drug discontinuation | B-III |
| Decreased accommodation and deposits in the lens | Common | Topical cholinergic agent | B-III | |
| Tricyclic antidepressants (amitriptyline) | Mydriasis, cycloplegia, blurred vision, presbyopia, mild and transient visual disturbances93 | Common | Improve with time as tolerance develops.93 Topical cholinergic agents (bethanechol or pilocarpine) | B-II |
| Decreased lacrimation, dry eyes, glaucoma attacks (anticholinergic) | Rare to common | Artificial tears, avoid in patients with narrow angles93 | B-II | |
| Selective serotonin reuptake inhibitors (sertraline, paroxetine, fluoxetine, citalopram) | Mydriasis, reduced accommodation, increased IOP, glaucoma,93 blurred vision | Common | Improve with drug discontinuation | B-III |
| Antihistamines (chlorpheniramine, meclizine, promethazine, diphenhydramine) | Mydriasis (anticholinergic)90, dry eyes, decreased accommodation | Common | Transient, reversible | B-III |
| Angle closure glaucoma (anticholinergic) | Rare | Avoid in patients with angle closure glaucoma | B-III | |
| Scopolamine patch | Anisocoria, mydriasis, dry eyes92 | Common | Avoid rubbing eyes with fingers after application of the patch92 | A-II |
| Voriconazole | Blurred vision, changes in visual acuity, color perception, photophobia, visual hallucinations89 | Common | Consider alternative drugs | A-III |
| Erectile dysfunction drugs(e.g., sildenafil) | Blue vision95 | Common | Improve with drug discontinuation | B-II |
| Non-steroidal anti-inflammatory drugs (topical) | Redness, stinging, corneal epithelial toxicity, stromal necrosis (corneal melts) especially in dry eyes | Occasional | Limit use for dry eye or GVHD, drug discontinuation96 | B-II |
IOP, intraocular pressure; GVHD, graft-versus-host disease.