Avanti Samel / March 15, 2002 10 Most Common Systemic Health Conditions with a Listing of Frequently Prescribed Medications and their Ocular Side Effects HYPERTENSION ACE Inhibitors: Captopril (Capoten}- blurred vision Enalapril (Vasotec) - Blurred vision, conjunctivitis, dry eyes, tearing Quinipril (Accupril)- amblyopia Benazepril (Lotensin)- N/A Lisinopril (Zestril) - Visual loss, diplopia, blurred vision, photophobia Beta-Blockers: Propranolol (Inderal)- visual disturbances, dry eyes Atenolol (Tenormin)- blurred vision, dry eyes, visual disturbances Metoprolol (Lopressor) - blurred vision, dry eyes calcium Channel Blockers: Diltiazem (Cardizem)- Amblyopia, eye irritation Amlodipine (Norvasc)- abnormal vision, conjunctivitis, diplopia, eye pain Verapamil (Calan)- Blurred vision Nifedipine (Procardia) - blurred vision, Transient blindness at the peak of plasma level · Diuretics: Thiazides: Chlorothiazide (Diuril) - Transient blurred vision, xanthopsia Loop: Furosemide (Lasix) - Blurred vision, Xanthopsia Potassium Sparing: Amiloride (Midamor) - Visual disturbances, Increased lOP Triamterene (Dyrenium)- N/A HYPERLIPIDEMIA Statins: Lovastatin (Mevacor) - Blurred vision, Eye irritation Simvastatin (Zocor)- Cataracts Atorvastatin (Lipitor)- Amblyopia, dry eyes, refraction disorder, eye hemorrhage, glaucoma Resins: Cholestyramine (Questran)- Uveitis Fibrates: Gemfibrozil (Lopid)- Blurred vision Niacin: Niacin (Niacor) - Toxic amblyopia, cystoid macular edema ASTHMA ( ) Beta 2 Agonists: Albuterol (Proventil) - N/A ( Salmeterol (Serevent)- N/A Corticosteroids: Fluticasone (Fiovent) - Irritation, Cataracts, glaucoma, increased intraocular pressure Leukotriene Antagonists: Montelukast (Singulair)- N/A HYPOTHYROIDISM Levothyroxine (Levothroid, Levoxyl, Synthroid, Unithyroid)­ Pseudotumor cerebri (children) Liothyronine (Cytomel)- N/A DIABETES Beta cell stimulators: Glipizide (Giucotrol) - Blurred vision, Pain in the eye, conjunctivitis and retinal hemorrhage Glyburide (Diabeta, Glynase) - Changes in accommodation and/or blurred vision Insulin Sensitizing Agents: Metformin (Giucophage)- N/A Rosiglitazone (Avandia)- N/A Inhibits breakdown of starch and sugars Acarbose (Precose)- N/A HORMONE R~PLACEMENT Conjugated estrogens/medroxyprogesterone acetate (Prempro, Premarin)­ Neuro-ocular lesions (e.g., retinal thrombosis and optic neuritis). Steepening of corneal curvature, intolerance of contact lenses Estradiol (Estrace, Estraderm, Vivelle, Climara, Alora and Fempatch)­ Neuro-ocular lesions (e.g., retinal thrombosis and optic neuritis). Steepening of corneal curvature, intolerance of contact lenses ADHD Psychostimulants: Methylphenidate (Ritalin) - Blurred vision Dextroamphetamine (Dexedrine, Dextrostat) - N/ A Pemoline (Cylert) - abnormal oculomotor function including nystagmus and oculogyric crisis Amphetamine Mixed Salts (Adderall)- N/A DEPRESSION Tricyclics: Amitriptyline (Eiavil) - blurred vision, disturbance of accommodation, increased ocular pressure, mydriasis Desipramine (Norpramin)- blurred vision, disturbance of accommodation, mydriasis, increased intraocular pressure Imipramine (Tofranil) - Blurred vision, disturbances of accommodation, mydriasis ( SSRis: Fluoxetine {Prozac)- Conjunctivitis, dry eyes, mydriasis, photophobia; ( Rare: Blepharitis, diplopia, exophthalmos, hemorrhage, glaucoma, iritis, scleritis, strabismus, visual field defect Paroxetine {Paxil) - Blurred Vision, Abnormality of accommodation, conjunctivitis, eye pain, mydriasis, photophobia, Rare: Amblyopia, anisocoria, blepharitis, cataract, conjunctival edema, corneal ulcer, exophthalmos, glaucoma, keratoconjunctivitis, night blindness, ptosis, retinal hemorrhage, visual field defect Sertraline {Zoloft) - Vision Abnormal, mydriasis, nystagmus, Conjunctivitis, abnormal accommodation, periorbital edema Rare: exophthalmos, anterior chamber hemorrhage, xerophthalmia, photophobia, diplopia, dry eye, scotoma, visual field defect MAOIs: Tranylcypromine (Parnate)- blurred vision ~heranfidep~nm: Venlafaxine (Effexor) - blurred vision, Mydriasis Nefazodone (Serzone) - blurred vision, abnormal vision, Visual field defect, eye pain, dry eye, abnormality of accommodation, diplopia, conjunctivitis, mydriasis, keratoconjunctivitis, photophobia. Rare: glaucoma, night blindness SEASONAL ALLERGIES Antihistamines and Decongestanm: Diphenhydramine hydrochloride (Benadryl) - blurred vision, diplopia Fexofenadine (Allegra)- xerostomia Loratidine (Ciaritin) - Conjunctivitis, blurred vision, xerostomia, eye pain, () blepharospasm Cetirizine {Zyrtec) - Visual Field Defect, conjunctivitis, eye pain, glaucoma, loss of accommodation, ocular hemorrhage, xerophthalmia Steriods: · Fluticasone propionate (Fionase)- Dryness and irritation, conjunctivitis, blurred vision, glaucoma, increased intraocular pressure, and cataracts Mometasone furoate (Nasonex)- Conjunctivitis ARTHRITIS NSAIDS: COX-2 Inhibitors: Rofecozib (Vioxx)- Blurred vision, conjunctivitis, ophthalmic injection Celecoxlb (Celebrex)- Blurred vision, cataract, conjunctivitis, eye pain Salicylates: Acetylsalicylic acid (Aspirin) - N/A Corticosteroids: Methypredinsolone {Medrol) - Pseudotumor cerebri, posterior subcapsular cataracts, increased intraocular pressure, glaucoma, exophthalmos Combination: Tramadol HCI {Uitram)- Visual disturbance, cataracts I '-.