m Eyes can be responsive to influence from

systemic or topical medication

m The adverse effect:
¬ Ãlurred vision
¬ Disturbance of color vision
¬ Scotomata
¬ Retina degeneration
¬ Other effet to cornea, sclera, lens, optic nerve,
extraocular muscle
m The effect from medication can be short term or
unpredicted
m igh Toxic systemic dose in short time
m Toxic that accumulate slowly even after
administration of drug ’ stopped (for e.g: liver
disease, renal disease)
m îndividual idiosyncracy
m Genetic
m Long time-use drug administration
m Digital glycosides
m Phenothiazine derivatives
m Chloroquine, hydroxychloroquine, quinine
m Ethambutol, ethionamide, chloramphenicol
m Other drug
m as been known for long time (1785, withering said
high dose given repeatedy may give occasion
sickness, vomit, confused vision)
m încidence: 25%
m 10% it even occur before other organ system¶s
reaction
m Common symptoms: blurred vision and disturbed color
vision after given digitalis.
m Photohphobia, scintillating scotomata may occur with
visual acuity disturbance.
m Thus: patient with unusual complain after digoxin
therapy shall be checked.
m ^pplebaum(1963): Rab(1969) said it can
adversely effect retina and other ocular structure
m Phenotiazine with peperidine --? More risk of
retinal toxicity than other phenotiazine
m Group phenotiazine also induce cataract’ anterior
polar variety
m Dose and duration may have the impact
m Retinopathy can be sudden loss of vision + retinal
edema or slowly.
m ydrochloroquine ’ dose related ’ frequently induce
keratopathy. this is still reversible after stop treatment.
m owever, This effect on retinal is progressive to loss
vision.
m Long term,dose of chloroquine must < 4 mg/kg/day
m ydroxychloroquine must < 6,5mg/kg/day
m Toxic dose for retinopatht:
¬ Chloroquine: 5,1mg/kg/day
¬ ydrochloroquine: 7,8mg.kg/day
m ruinine: acute high dose ’ ocular problem, including
blindness
m Optic Neuritis
m Dose related
m înfrequent dose at 15mg/kg/day
m Dosage also reduced if patient¶s gfr < 30-50ml
m Retrobulbar neuritismay also happen, with
symptoms:
¬ înclude decrease visual acuity
¬ Scotomata
¬ Defective red-green vision
m Transdermal Scopolamine patch: anisocoria,
dilated pupil, glaucoma
m Viagra: blue tint of vision
m Educate and inform the patient