7,8 One can postulate that any medication with such effects would decrease the quantity of tear production. Medications that have anticholinergic effects, such as tricyclic antidepressants (TCAs), may cause decreased lacrimation. ![]() Psychiatric medications also can act to alter both the quantity and quality of tears. Antidepressants-tricyclic antidepressants, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, norepinephrine reuptake inhibitors and monoamine oxidase inhibitors.4 Typical antipsychotics are known to have more severe toxicity, which can be related to either high dose or cumulative dosing, depending on the condition being considered. “atypical” antipsychotics has less to do with their efficacy and more to do with their side effect profile. Antipsychotics (typical and atypical) the delineation of “typical” vs. ![]() 3 They can loosely be categorized into six groups: These drugs work by altering levels of particular neurotransmitters in the brain. 5 The condition elicits minimal visual consequences and usually regresses with appropriate intervention, such as dose tapering. 5 This presentation has been linked to high dosages (>2g/day) of the medication. 5 The manifestation seen with chlorpromazine use is noted to have a distinctive pattern of swirling lines or fine streaks in the epithelium, reminiscent of Plaquenil (Covis Pharmaceuticals) keratopathy. 6 Visual impairment is irreversible without prompt identification and cessation of the medication.Ĭhlorpromazine in particular, a member of the phenothiazine family, has been noted to cause corneal epithelial keratopathy. 5,6 This can lead to impaired endothelial pump function, causing severe corneal edema and consequent severe visual effects. 6 This is linked to total dosage of medication. Phenothiazines (typical antipsychotics), for example, can cause phototoxic lysis of the corneal endothelium. Early recognition can ensure the patient is able to continue the appropriate treatment for their underlying disorder. 5 Timely and appropriate management of these complications can prevent permanent ocular surface damage and impaired vision. No pigmentary retinopathy was noted.ĭrug toxicity to the ocular surface can manifest as epithelial keratopathy, corneal edema and altered tear film quantity and quality. Note the fine golden-brown dust-like deposits on the corneal endothelium, greatest inferiorly, and anterior subcapsular opacity in a stellate pattern in both eyes. Her best-corrected visual acuity is 20/20 OU. ![]() No previous history of typical antipsychotic medication use. 4 Two systemic considerations that, although not directly related to the eye, can have ocular consequences include increased risk of metabolic syndrome, specifically diabetes, and cerebrovascular events.Ī 54-year-old black female with pertinent history of clozapine 100mg PO daily use for schizophrenia. Proposed ramifications of ocular toxicity include: ocular surface and ocular pigmentation complications, cataracts, accommodative interference, angle closure glaucoma, retinopathy and neuropathy, ocular motility disorders and impaired sensory perception. ![]() The astute clinician should be aware of these agents and their potential complications so that timely intervention can be started to prevent permanent sequelae. A standardized approach for monitoring ocular toxicities from these medications and others would be helpful. 4 As such, optometrists should follow individuals placed on these agents diligently. 1Īlthough many potential neurological complications exist, the eye is the second most common site to manifest drug toxicity, outshined only by the liver. 1,2 Furthermore, half of all lifetime cases are known to begin by age 14 and three quarters by age 24. Whether it’s short-term use of an antidepressant to cope with the loss of a loved one or a lifelong reliance on an anti-schizophrenia drug to function normally in everyday life, approximately 46% of Americans will meet the criteria for a DSM-IV and -V ( Diagnostic and Statistical Manual of Mental Disorders ) disorder at some point in their lifetime. Psychoactive drugs are prescribed frequently for a variety of conditions that alter mood and emotional status.
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