Drugs that may induce transient hyperopia

Topical anticholinergic agents Tropicamide Antidepressants

Cyclopentolate hydrochloride Imipramine
Homatropine Amphetamines
Scopolamine Monoamine oxidase inhibitors
Atropine sulfate Local anesthetic
Systemic anticholinergic antagonist agents Cocaine
Antihistamines Antidiabetic agents
Anti-inflammatory analgesics Chlorpropamide (Hypoglycemic)
Salicylates Oral contraceptive
Sedatives & hypnotics Chloral hydrate, overdose NSAID
Antipsychotic agents Phenothiazines (sedative & Indomethacin
tranquilizer)

Drugs that may induce transient myopia

Anti-glaucoma agents Pilocarpine

Carbachol
Physostigmine
Neostigmine
Carbonic anhydrase inhibitor
Isoflurophate
Antibiotics Sulfonamides
Tetracycline
Isoniazid
Antianginal agents Isosobide dinitrate
Antihypertensive Adrenergic drugs
Antiallergy agents Antihistamines
Anticonvulsants Methsuximide
CNS Morphine
Phenothiazines
Heavy metals Arsenicals
Hormonal agents Adrenocorticotropic hormone
Corticosteroids
Oral contraceptive
Analgescis Aspirin

Mechanism of transient drug-induced myopia

 3 mechanisms
 Substained contraction of the ciliary muscle  increased refractivity of the lens
 Increases refractive power of the lens contents as result of water imbibition
 Swelling of the ciliary process causing forward displacement of the lens
 Supraciliary choroidal effusion causing forward displacement of the ciliary body-lens-iris block & relaxation
of zonular fibres leading to myopia, anterior chamber shallowing + angle closure glaucoma

Drugs that can affect structures of the eye

Decreasing aqueous tear

secretion
Antianxiety agents Chlorodiazeposide
Diazepam
Antichlolinergics Atropine
Scopolamine
Antihistamines Chlorpheniramine
Diphenhydramine
Beta-Adrenergic blockers Practolol
Prepranolol
Phenothiazines Chlorpromazine
Thioridazine
Tricyclic antidepressants Amitripryline
Doxepin
Vitamin A analogues Isoretinoin Impairment of dark adaptation
Increasing aqueous tear secretion
Adrenergic agonists Ephedrine Increasing aqueous tear secretion
Antihypertensives Reserpine Increasing aqueous tear secretion
Hydralazine
Cholinergic agonists Neostigmine
Antipyschotics Chlorpromazine Blue discoloration of the dermis of
the lids
Sulfonamides Lid odema
Salicylate Nystagmus
Phenytoin Nystagmus
Antihistamines Nystagmus
Gold salts Nystagmus
Barbiturates Nystagmus
Phenothiazines Diplopia
Antianxiety Diplopia
Antidepressants Diplopia
Alcohol Impairment of version movement

Ethambutol  Optic neuritis

 Color vision loss
 Visual field defect
Chloramphenicol  Optic neuritis
 Retrobulbar neuritis
Isoniazid  Optic neuritis
Oral contraceptives  Pseudotumor cerebri
Corticosteroids
Tetracycline
Tamoxifen  Optic neuritis
 Whorl-like corneal subepithelial deposits
Amiodarone (anti-arrhythmia)  Papillitis
 Vortex keratopathy
Chloroquine & Hydroxychloroquine  RPE changes
 Visual field defect
 Color vision loss
Indomethacin  Stromal opacities or whorl-like epithelial opacities
 Pigmentary changes
 Color vision loss
 Visual field defects
Quinine  Impairment dark adaptation
 Visual field defect

Thiotidazine
Amentadine
Allopurinol
Rifabutin (anti-mycobacterium)
Cidofovir (for AIDS)
Topiramate (antiseizure)
Vigabatrin (anti-epileptic)
 Vascular attenuation
 RPE changes
 Color vision loss
 Visual field defect
 White punctate opacities associated with epithelial oedema
 Anterior subcapsular lens opacitis
 Photosensitivity
 Hypopon anterior uveitis, intermediate uveitis, panuveitis, retinal
vasculitis
 Uveitis
 Acute angle-closure glaucoma with associated myopia
 Nystagmus
 Diplopia
 Blur vision
 Visual filed constriction
 Color vision loss

Schizophrenia

Aripiprazole  Mydriasis
 Myopia
 Blepharospasm
Chlorpromazine  Abnormal pigmentation of eyelids, cornea (endo & Descemet) & conjunctival
 Visual impairment & retinopathy
 Anterior lens lens stellate cataract
 Subcapsular dust-like granular deposits-whitish to yellowish brown in the
pupillary area
 Blue-yellow color vision
 Retrobulbar injections secondary diffuse orbital fibrosis & neurotrophic
 Corneal ulcer
Fluphenazine  Bilateral maculopathy
Thioridazine  RPE atrophy
 Bull’s eye changes
 Cataract
Clozapine, Loxapine  Nystagmus
 Ptosis
 Mydriasis
 Decrease vision
Haloperidol  Mydriasis
 Visual hallucination
 Decrease IOP, vision
 Myopia
 Allergic conjunctiva & eyelids
Pimozide  Dry eye
 Visual hallucination
 Blurred vision
Questiapine fumarate  Dry eye
 Retinal vein occlusion
Thiothixene  Mydriasis
 Blur vision
 Corneal or lens deposits
 Photosensitivity
Side effects of ocular drugs

Ocular Systemic
Cholinergic/Anticholinesterase  Accommodative spasm  Headache
 Miosis  Browache
 Follicular conjunctivitis  Marked salivation
 Pupillary block with secondary  Profuse perspiration
angle-closure glaucoma  Nausea
 Band keratopathy  Vomiting
 Allergic blepharoconjunctivitis  Bronchospasm
 Retinal detachment  Pulmonary odema
 Conjunctival injection  Systemic hypotension
 Lid myokymial  Bradycardia
 Anterior subcapsular cataract  General muscular weakness
 Iris cyst formation  Increased tone & motility of
GIT
 Respiratory paralysis
Beta blockers  Irritation & itching  Headache
 Tearing  Lethargy (lack of energy)
 Dry eye  Mental depression
 Superficial punctate keratitis  Dissociative behaviour
 Corneal hypoesthesia  Memory loss
 Allergic blepharoconjunctivitis  Bradycardia, cardiac
 Blurred vision arrhythmia
 Photophobia  Palpitations
 Persistent hypotony  System hypotension
 Orthopedic-joint pain
 Bronchospasm
 Skin rash
 Nausea,vomiting
Cyclopentolate  Irritation & lacrimation  Drowsiness
 Conjunctival hyperemia  Incoherent speech
 Allergic blepharoconjunctivitis  Ataxia
 Elevated IOP  Visual hallucinations
Phenylephrine  Lacrimation  Occipital hemorrhage
 Transient pain  Tachycardia
 Keratitis  Subarachnoid hemorrhage
 Rebound miosis, conjunctival  Systemic hypertension
congestion
 Pigmented aqueous floaters
Epinephrine  Irritation & lacrimation  Severe headache
 Conjunctival hyperemia  Tachycardia
 Allergic blepharoconjunctivitis  Anxiety
 Pupillary dilation  Palpitation
 CSME
 Elevated IOP
Atropine  Erythema with pruritus  Flushing of the face
 Allergic papillary conjunctivitis  Hyperthemia
 Allergic keratitis  Ataxia
 Depression
https://www.richmondeye.com/ocular-side-effects-of-medications

https://sci-hub.hkvisa.net/10.2165/11533180-000000000-00000