++
KEY CONCEPTS
The eye is highly susceptible to drug toxicity due to its extensive vasculature.
When ophthalmic disorders occur, all medications and biologic agents, irrespective of the route of administration, are potential causes.
It 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.
The most common drug-induced ophthalmic disorders include dry eye, cataract, intraoperative floppy iris syndrome, optic neuropathy, and retinopathy.
The severity of drug-induced ophthalmic disorders varies and depends on dose, pharmacokinetics, genetic predisposition, age, extremes of body weight, and/or duration of exposure.
Health professionals and patients should discuss potential drug-induced ophthalmic disorders to ensure awareness, prompt identification, management, and treatment.
++
Patient Care Process for Drug-Induced Ophthalmic Disorders
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
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.
++
The 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)....