Published in Primary Care

Ocular Side Effects of Common Medications: Downloadable Cheat Sheet

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2 min read
Download this gorgeous guide for need-to-know info on how common medications can affect the eyes!
Ocular Side Effects of Common Medications: Downloadable Cheat Sheet
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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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/typeEffect
AccutaneBlepharoconjunctivitis Dryness Lid edema
NSAIDs and other blood thinnersSubconjunctival heme
SulfonamidesSteven-Johnson syndrome Lid edema
TetracyclinesPigmented cysts on conjunctiva
Sildenafil (Viagra)Subconjunctival hemorrhage Conjunctival hyperemia
ProstaglandinsConjunctival hyperemia Inc eyelash growth Inc pigment of periorbital skin & eyelashes
TamifluConjunctivitis 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/typeEffect
DigoxinBlue-yellow defect Entoptic phenomena (snowy/flickery vision)
AccutanersAffects color vision and may cause night blindness
ViagraCyanopsia ("blue pill: blue-tinted vision")
EthambutolRed/Green discrimination

Want the cheat sheet? Download it now!

What mnemonics do you use to remember drugs and their side effects? Share them in the comments!
Maria Martinez, OD
About Maria Martinez, OD

Dr. Maria Martinez is an optometrist currently completing her residency in ocular disease at Aran Eye Associates. She graduated from Nova Southeastern University College of Optometry in Fort Lauderdale, FL. Dr. Martinez sees a variety of patients in a busy OD/MD practice. She has a passion for helping patients understand the importance of vision and hopes to enhance eye care in minority communities. Outside of the exam room she showcases her balanced lifestyle of eye health, fashion, travel and her miniature goldendoodle, Maddox through her IG @EyeDocMaria.

Maria Martinez, OD
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