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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Download the full cheat sheet for quick reference to ocular side effects of common medications.
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 |
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What mnemonics do you use to remember drugs and their side effects? Share them in the comments!
