Monitor Eyes of Patients Prescribed Systemic Drugs

Close-up of senior black woman sorting weekly medication. Member of a black middle class America family.
Nathan Lighthizer, OD, explains the top pharmaceutical offenders and patient-specific factors that can increase the risk of ocular adverse drug reactions.

The following article is a part of Ophthalmology Advisor’s conference coverage of the Southeastern Educational Congress of Optometry (SECO) 2021, held in Atlanta and virtually from April 28 to May 2, 2021. The team at Ophthalmology Advisor will be reporting on the presentations offered by these leading experts in optometry and ophthalmology. Check back for more from the SECO 2021 Meeting.


The eye is at risk for ocular adverse drug reactions (OADRs), with known factors increasing that risk, for multiple reasons. One of those is its rich blood supply, which permits systemic drugs to reach the eye via uveal and retinal blood vessels.

In the presentation “Ocular Effects of Systemic Medications” Nate Lighthizer, OD, FAAO, will detail this and more at the Southeastern Educational Congress of Optometry (SECO) 2021 meeting. Dr Lighthizer is an educator with Northeastern State University Oklahoma College Of Optometry.

He’ll discuss 2 other reasons that the eye is at risk for OADRs: Its relatively small mass and ocular tissues themselves. “Ocular tissues can act as drug reservoirs, enhancing the potential for toxicity,” Dr Lighthizer’s presentation slide says. Those tissues are associated with ocular functions that patients can express, such as change of acuity, ptosis, color vision changes, and others. 

“OADRs are more commonly noticed than the mild reactions that occur elsewhere in the body,” his slides explain.

Factors that increase OADR risk can include product specific variables and patient specific risks. Product specific includes the amount of drug administered — for instance, all medications can be toxic if given in excess amounts, and long-term use can increase that toxicity as well. The nature of the drug can also be an issue — its ease of absorption into systemic circulation, and if it can penetrate barriers such as the blood-brain, blood-aqueous, and blood-retinal. Finally, the route of administration can be a risk factor: “Highest levels of adverse effects have been seen with oral administration (over inhaled, intranasal, etc.),” Dr Lighthizer says.

The patient specific risks include pathophysiologic variables in liver and kidney function; age, with the very young and very old most susceptible; gender, with adverse reactions more common in women than men; a history of an allergy or allergies to drugs; individual idiosyncrasy, like enzymatic differences and muscle mass; and possibly genetics, with altered tissue responsiveness to medicine likely hereditary, according to the presentation. Drug interactions are important, too, as is asking patients about things like any supplements they are taking and social habits that might impact medication usage. 

One slide lists all of the major pharmaceutical offenders, including hydroxychloroquine, which the presentation focuses on, highlighting hydroxychloroquine toxicity such as its symptoms, risk factors, screening guidelines, and a case presentation. “Toxicity risk is low, but lots of different screening recommendations have been proposed,” the presentation says. Other medications discussed include amiodarone, sildenafil, topiramate, and tamoxifen.

The presentation also reviews numerous ocular conditions and their medical associations, including pseudotumor cerebri, non-arteritic anterior ischemic optic neuropathy, and central serous chorioretinopathy.

Ocular concerns associated with common medications are outlined and include vascular lesions of the retina, which can include retinal vascular abnormalities, occlusions, venous thrombosis, or retinal hemorrhages.

Disclosure: Presenter declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.  

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Lighthizer N. Ocular Effects of Systemic Medications. Presented at: Southeastern Educational Congress of Optometry (SECO) 2021 Annual Meeting; April 28-May 2, 2021; Atlanta, GA. Course 127.