WebMD Health - Eye Health

Sep 27, 2011 4:43 PM

Could My Medications Cause Vision Problems?

Most of us know that medicine can sometimes cause side effects such as dry mouth. But did you know that medications can also cause vision problems such as dry eyes or sensitivity to light? Some drugs can even lead to serious eye problems or vision loss.

"It's very important for people to be aware of what conditions they have, what medications they're taking, and how they may increase risk of certain eye problems," says Scott Greenstein, MD, FACS, instructor in ophthalmology at Harvard Medical School in Boston. "Most of these medicines are perfectly safe, and you never get into a problem with them," he says, but a small percentage can cause vision problems.

When taking a medication, be sure to tell your doctor about any vision problems. Catching problems early can prevent permanent damage to your eyesight. In some cases, your doctor may want to monitor your eyesight while you take a medication.

Below are 10 types of drugs that may cause vision side effects. This list is not comprehensive, so if you have any questions about a drug you take, be sure to talk with your doctor.

1. Acne Medication

Generic name: Isotretinoin

Brand names: Accutane, Amnesteem, Claravis, Sotret

Isotretinoin treats severe acne that has not responded to other treatments. Vision symptoms may include dry eyes and a sudden decrease in night vision, Greenstein says, so be careful when driving at night.

How to prevent vision problems: This medication can cause a number of other serious side effects, so your doctor will monitor you while you are taking it.

2. Antihistamines

Antihistamines relieve hay fever and other allergy symptoms. They work by blocking histamines produced by the body that cause a runny nose, watery eyes, sneezing, and itching. In some people, these drugs can cause an emergency condition called angle-closure glaucoma, which occurs when the pressure inside the eye increases rapidly. Symptoms include headache, severe eye pain, nausea and vomiting, blurred vision, and seeing halos around lights.

"Glaucoma is a very common disease, especially in people over 40," says Richard G. Shugarman, MD, a member of the editorial board of the American Academy of Ophthalmology and voluntary professor of ophthalmology at the Bascom Palmer Eye Institute, University of Miami School of Medicine. Glaucoma basically falls into two categories, open angle and narrow angle, he says. Most people with glaucoma have open angle, while a small percentage have narrow angle.

If you have narrow angles, says Shugarman, who also runs a private practice in West Palm Beach Florida, you should not take any types of drugs that might dilate your pupils, such as antihistamines. You also need to avoid taking anticholinergics, or antispasmodic medications, he says. These may include scopolamine patches for sea sickness and drugs that calm diarrhea and muscle spasms in people with gastrointestinal problems.

How to prevent vision problems: If you notice severe eye pain, sudden visual blurring, or other symptoms of angle closure glaucoma, get immediate medical help. Glaucoma usually has no symptoms, so you can have it and not know it. Regular eye exams can detect glaucoma early on and help prevent vision loss.

3. Antimalarial drugs

Generic and brand names: hydroxychloroquine (Plaquenil, Quineprox), chloroquine (Aralen)

These medications treat rheumatoid arthritis and lupus, and they can prevent or treat malaria. While rare, some people who take these medications over time can develop retinal toxicity, leading to permanent vision loss. "Plaquenil toxicity of the retina is typically dose related," says Greenstein. "In other words, you have to be on a lot of it for a long time in order to be at a high risk."

How to prevent vision problems: Before taking these medications, you should be examined by an ophthalmologist. "Patients often come in for a base-line study to be sure their eyes are healthy before going on it," says Greenstein. Patients taking antimalarials on a daily basis need to be checked yearly after that.

4. Corticosteroids

Generic name: prednisone

Brand names include: Deltasone, Meticorten, Orasone, Prednicot, Sterapred

Prednisone is a type of corticosteroid used to treat conditions such as arthritis, lupus, psoriasis, severe allergies, ulcerative colitis, and breathing disorders. "Prednisone is well known to increase a patient's risk of developing cataract or glaucoma," says Greenstein. "A certain percentage of people who take prednisone are what we call 'steroid responders.'" The drug can cause an elevation in eye pressure, which is a major risk factor for developing glaucoma, he says.

How to prevent vision problems: If you notice vision symptoms such as eye pain, halos around lights, or blurred vision, call your doctor right away. If you take corticosteroids often, get a comprehensive eye exam once a year to check for glaucoma or cataracts.

5. Erectile Dysfunction Drugs

Generic and brand names: sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra)

Men taking these drugs for erectile dysfunction (ED) have reported blurred vision, sensitivity to light, and seeing a temporary blue tinge to objects. Commercials for these drugs also warn of sudden vision loss, which may or may not be associated with the medicines. "There's something called nonarteritic anterior ischemic optic neuropathy, which can occur," says Greenstein, "but many specialists here and elsewhere don't necessarily believe that ED drugs are causing it. This problem with ischemic optic neuropathy often happens in older people who may have poor circulation to begin with, and that's why they may have ED," he says. "It may be a coincidence that they get this nerve problem when they're on this medication."

How to prevent vision problems: Call your doctor right away if you notice vision changes while taking ED drugs.

6. Ethambutol

Brand name: Myambutol

Ethambutol is a type of antibiotic used to treat tuberculosis (TB). According to Greenstein, this medication can be associated with optic nerve problems. This can cause a loss of visual acuity, or clarity, and difficulty seeing certain colors. Another TB drug, Isoniazid (Tubizid) also may cause eye problems.

How to prevent vision problems: Call your doctor for any visual changes including problems seeing certain colors.

7. Flomax

Generic name: tamsulosin

Flomax is used to treat men with an enlarged prostate who have trouble passing urine. It's part of a class of drugs called alpha blockers, which work by relaxing certain muscles, making it easier to urinate. The problem, according to Shugarman and Greenstein, is that the medication builds up in the iris of the eye.

"It can prevent the pupil from dilating," says Greenstein, "and it can also cause something called IFIS, intraoperative floppy iris syndrome." During cataract surgery on someone who has taken the drug, he says, "the eye can literally misbehave in the middle of the operation. It can make the surgery very difficult."

How to prevent vision problems: "If you are a man taking any of those drugs for your prostate, and you're considering having cataract surgery, please make sure your ophthalmologist knows," says Shugarman. "There are certain precautions we can take before and during surgery" to prevent problems.

8. Phenothiazines

Generic names and brand names: chlorpromazine (Thorazine), thioridazine (Mellaril)

Phenothiazines are antipsychotic medications used to treat schizophrenia and other mental illnesses. Medication side effects include sensitivity to light, changes in color vision, blurred vision, and problems seeing at night. They can also cause pigmentary changes in the lens of the eye, which usually doesn't cause eye problems, Greenstein says. "If you get pigmentary changes in the retina, that can cause vision problems."

How to prevent vision problems: Vision changes with these drugs seem to be related to higher doses and longer-term use. If you notice any vision changes, be sure to tell your doctor.

9. Tamoxifen

Brand names: Soltamox, Nolvadex

Tamoxifen is an antiestrogen drug used to treat breast cancer. It can lead to a condition called crystalline retinopathy, where small, crystal-like deposits form in the retina, Greenstein tells WebMD. "There can be functional and anatomical changes in the retina associated with tamoxifen." Medication side effects also may include blurred vision, corneal changes, and an increased risk for cataracts.

How to prevent vision problems: If you take tamoxifen, it's a good idea to see an ophthalmologist for an annual eye exam. Also be sure to tell your doctor if you notice any eye symptoms.

10. Topiramate

Brand names: Topamax, Topiragen

Topamax is an anticonvulsant used to treat seizure disorders such as epilepsy and to prevent migraine headaches. This medication is also associated with angle-closure glaucoma, says Greenstein, so patients need to be aware of it.

How to prevent vision problems: If you have sudden vision changes, headache pain around the eyes, blurred vision, or double vision, get medical help. Angle-closure glaucoma is an ophthalmic emergency, says Greenstein, and needs immediate treatment.

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