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KEY CONCEPTS

KEY CONCEPTS

  • imageThe eye is highly susceptible to drug toxicity due to its extensive vasculature.

  • imageWhen ophthalmic disorders occur, all medications and biologic agents, irrespective of the route of administration, are potential causes.

  • imageIt is difficult to fully quantify the incidence of drug-induced ophthalmic disorders due to the variety of causative factors and side-effect reporting behaviors of clinicians.

  • imageThe most common drug-induced ophthalmic disorders include dry eye, cataract, intraoperative floppy iris syndrome, optic neuropathy, and retinopathy.

  • imageThe severity of drug-induced ophthalmic disorders varies and depends on dose, pharmacokinetics, genetic predisposition, age, extremes of body weight, and/or duration of exposure.

  • imageHealth professionals and patients should discuss potential drug-induced ophthalmic disorders to ensure awareness, prompt identification, management, and treatment.

PATIENT CARE PROCESS

Patient Care Process for Drug-Induced Ophthalmic Disorders

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Collect

  • Patient characteristics (eg, age, sex, pregnancy status)

  • Patient medical history (personal and family)

  • Social history (eg, tobacco/ethanol use)

  • Current or recently discontinued medications including prescription, over-the-counter (OTC) aspirin/NSAID use, herbal products, dietary supplements

  • Objective data (eg, drug levels)

Assess

  • Appearance of ophthalmic signs or symptoms

  • Presence of predisposing conditions or risk factors

  • Presence of physical occlusion of the eye or eyelid

  • Presence of common provoking factors (eg, recent drug use, new medications, history of allergies)

  • Potential causative agent

  • Appropriateness for self-care (eg, red flags that would indicate referral or higher level of care)

  • Ability/willingness to administer eye drops appropriately (eg, health literacy, age of patient)

  • Ability/willingness to pay for OTC options not covered by insurance

  • Ability/willingness to follow-up with the provider if symptoms do not improve

Plan

  • Discontinuation of the offending agent, if applicable

  • Pharmacologic and nonpharmacologic treatment regimen with medication(s), dose, route, frequency, and duration of treatment (see Table e116-4)

  • Monitoring parameters including efficacy (eg, resolution/improvement in symptoms); frequency and timing of follow-up

  • Patient education (eg, purpose of treatment, medication administration technique)

  • Self-monitoring for resolution of symptoms

  • Referral to other providers when appropriate

Implement

  • Provide patient education regarding all elements of the treatment plan

  • Use motivational interviewing and coaching strategies to maximize adherence

  • Schedule follow-up labs (eg, drug levels) and/or ophthalmic examination

Follow-Up: Monitor and Evaluate

  • Resolution of eye symptoms

  • Drug level results, as appropriate

  • Presence of adverse effects

  • Patient adherence to treatment plan and scheduled care visits

  • Schedule regular ophthalmic examinations

  • Reevaluate as necessary

BEYOND THE BOOK

BEYOND THE BOOK

Watch the following videos available from the US National Library of Medicine MedlinePlus for a brief overview of the anatomy and function of the eye. These videos provide the necessary foundation and will assist in understanding the mechanisms of drug-induced ophthalmic disorders.

INTRODUCTION

imageThe eye is an important, complex organ of the nervous system. It is composed of specialized tissues and complex structures that collectively contribute to the body’s ability to visually process the environment (Fig. e116-1)....

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