Adverse ocular effects of neuroleptic therapy: semiotics, pathogenesis and treatment

Antipsychotics are widely used in psychiatric practice for treating schizophrenia, bipolar disorder, and other diseases, including those treated off-label. They manifest many adverse effects, including ophthalmic ones. Some of these effects, such as persistent mydriasis, cycloplegia, extraocular muscle dystonia, and visual hypersensitivity attacks are reversible, since they disappear after dose reduction or drug withdrawal. Yet other side effects, such as cataracts, corneal edema, acute angle closure glaucoma and retinopathy are threatening for sight and may lead to permanent visual acuity decline and even blindness. The review provides data on the incidence of ocular side effects (both typical and atypical) of multiple antipsychotics, their clinical manifestations, pathogenesis and treatment. Eye examination is recommended for patients taking antipsychotics in the early periods of treatment and then twice a year. The psychiatrists need to know about the adverse effects of individual drugs whilst the ophthalmologists should be aware of their semiotics, pathogenesis and treatment, since timely diagnosis and treatment of pathological changes, together with antipsychotic therapy modification, prevent the development of severe and irreversible visual impairment in the majority of cases.

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A Rare Serious Ocular Side Effect of Topiramate: Bilateral Acute Angle Closure Glaucoma

Indian Journal of Emergency Medicine ◽

10.21088/ijem.2395.311x.3217.14 ◽

2017 ◽

Vol 3 (2) ◽

pp. 255-257

Author(s):

Dhruvkumar M. Patel ◽

◽

Mukundkumar V. Patel ◽

Ajay V. Garg ◽

◽

...

Keyword(s):

Side Effect ◽

Acute Angle ◽

Angle Closure Glaucoma ◽

Angle Closure ◽

Ocular Side ◽

Acute Angle Closure ◽

Ocular Side Effect ◽

Acute Angle Closure Glaucoma

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Ocular Adverse Effects of Antidepressants – Need for an Ophthalmic Screening and Follow up Protocol

Ophthalmology Research An International Journal ◽

10.9734/or/2019/v10i330107 ◽

2019 ◽

pp. 1-6

Author(s):

Varsha Narayanan

Keyword(s):

Side Effects ◽

Adverse Effects ◽

Selective Serotonin Reuptake Inhibitors ◽

The Elderly ◽

Visual Disturbance ◽

Significant Rise ◽

Angle Closure ◽

Ocular Side ◽

Screening Protocol

Depression is emerging to be one of the commonest mental health disorders worldwide affecting a wide age group. The prescription of antidepressants has risen considerably in last decade with a preference for using newer antidepressants like Selective Serotonin Reuptake Inhibitors (SSRIs). There have been many published reports of Ocular side effects with Antidepressants related to Dry eye, Visual disturbance, Angle closure glaucoma and Retinal effects. There has also been a significant rise in antidepressant usage by the elderly, which is a population at risk for ocular adverse effects. Therefore, it is pertinent to understand the antidepressants from the perspective of their mechanisms of action and all possible Ocular adverse effects, and develop an Ophthalmic screening protocol and follow up for patients being put on Antidepressants. Patients should also be counselled for reporting alert signs of ocular side effects immediately. These steps may help to avert and decrease visual complications with Antidepressants.

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Acetazolamid orális alkalmazása mellett jelentkező chorioidealeválás két esete: ismert idioszinkráziás hatás szokatlan megjelenési formája?

Orvosi Hetilap ◽

10.1556/650.2017.30944 ◽

2017 ◽

Vol 158 (50) ◽

pp. 1998-2002 ◽

Cited By ~ 2

Author(s):

András Hári-Kovács ◽

Judit Soós ◽

Tamás Gyetvai ◽

Andrea Facskó ◽

Mihály Végh

Keyword(s):

Acute Angle ◽

Angle Closure ◽

Drug Induced ◽

Ocular Side ◽

Sulpha Drugs ◽

Acute Elevation ◽

Sulpha Drug ◽

Acute Angle Closure ◽

Choroidal Effusion ◽

Acute Angle Closure Glaucoma

Abstract: Sulpha drugs are widely employed in medicine for various diseases and disorders. During the last several decades, numerous papers had been published on supra ciliary and posterior choroidal effusion likely presenting as an idiosyncratic effect of these drugs especially of acetazolamide. In each publication, the effusion was associated with either an acute angle-closure glaucoma or transitory myopia or both of these as leading symptoms. In the current publication, authors report on two cases where the acetazolamide-induced choroidal effusion was an accidental finding without either a myopic shift in refraction or an acute elevation in intraocular pressure. To our best knowledge, ours is the first report in the literature describing this unusual, “silent” form of a sulpha drug-induced choroidal effusion. Since the choroidal involvement may vary in size and location, and is not necessarily associated with acute glaucoma and myopia, one can assume that a considerable amount of acetazolamide-related ocular side-effects will not be discovered. The above case report aims to draw the attention of other specialities to the need for ophthalmic examination for their patients taking sulpha drugs with acute visual deterioration. Orv Hetil. 2017; 158(50): 1998–2002.

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Side effects of psychotropic drugs on eye

Clinical ophthalmology ◽

10.32364/2311-7729-2021-21-1-29-33 ◽

2021 ◽

Vol 21 (1) ◽

pp. 29-33

Author(s):

A.A. Petukhova ◽

◽

A.A. Panov ◽

Ya.V. Malygin ◽

M.A. Kazanfarova ◽

...

Keyword(s):

Side Effects ◽

Adverse Effects ◽

Psychotropic Drugs ◽

Serotonin Reuptake ◽

Selective Serotonin Reuptake Inhibitors ◽

Tricyclic Antidepressants ◽

Vision Loss ◽

Acute Angle ◽

Serotonin Reuptake Inhibitors ◽

Angle Closure

Any antipsychotics provoke more or less ocular complications. Some of them are relatively harmless (i.e., dark eyelids, conjunctival and corneal pigmentation, mydriasis, nystagmus, dry eye etc.). These adverse effects are resolved spontaneously after treatment discontinuation, drug switching, or prescribing additional therapy. However, the intake of both typical and atypical neuroleptics, lithium salts, some anticonvulsants (e.g., topiramate) is associated with high risks of vision loss. Moreover, in some patients these medications may result in blindness. The use of psychotropic drugs (e.g., tricyclic antidepressants or serotonin reuptake inhibitors) in patients with higher risk of acute angle closure is of particular concern. The association between phenothiazines and anticonvulsants and retinopathy, chlorpromazine and cataract, anticonvulsants and poor color vision and reduced contrast sensitivity is also important. Psychiatrists and ophthalmologists should consider potential ocular side effects in patients receiving psychotropic drugs. Knowing management algorithm for these conditions is also important. The number of recent publications on this issue is limited. Therefore, articles older than 10 years are sometimes used. Keywords: eye, visual organ, adverse effects, psychotropic drugs, neuroleptics, tricyclic antidepressants, selective serotonin reuptake inhibitors, glaucoma, retinopathy, cataract. For citation: Petukhova A.A., Panov A.A., Malygin Ya.V., Kazanfarova M.A. Side effects of psychotropic drugs on eye. Russian Journal of Clinical Ophthalmology. 2021;21(1):29–33. DOI: 10.32364/2311-7729-2021-21-1-29-33.

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Bilateral simultaneous acute angle closure in an adult Nepalese woman

Asian Journal of Ophthalmology ◽

10.35119/asjoo.v16i1.348 ◽

2018 ◽

Vol 16 (1) ◽

pp. 51-54

Author(s):

Sabin Sahu ◽

Lila Raj Puri

Keyword(s):

Intraocular Pressure ◽

Corneal Edema ◽

Acute Angle ◽

Posterior Segment ◽

Angle Closure ◽

Laser Peripheral Iridotomy ◽

Peripheral Iridectomy ◽

Acute Angle Closure ◽

The Right ◽

Peripheral Iridotomy

Purpose: To report a case of bilateral simultaneous angle closure in an adult Nepalese woman without any known secondary cause. Methods: Observational case report. Results: A 50-year-old Nepalese woman presented with decreased vision, pain, redness, and watering in both eyes with associated coloured haloes, nausea, and vomiting for 10 days. At presentation, her visual acuity was 20/400 in the right eye and hand motions close to face with accurate projection of rays in the left eye. Intraocular pressure was 38 mmHg in the right eye and 48 mmHg in the left eye without any antiglaucoma medications. A slit-lamp examination revealed bilateral circum-corneal conjunctival congestion, corneal edema, and shallow anterior chambers. Both pupils were mid-dilated and non-reactive to light. Gonioscopy showed closed angles in all four quadrants bilaterally. Posterior segment examination revealed normal optic disc with cup-disc-ratio of 0.3 in the right eye, and blurring of disc margin with cup-disc-ratio of 0.3 in the left eye. The patient was started on systemic acetazolamide 250 mg 4 times a day, topical brimonidine 0.2% and timolol 0.5% 2 times a day, and topical dexamethasone 6 times a day in both eyes, following which IOP reduced to 11 and 12 mmHg, respectively, the corneal edema subsided, but the anterior chamber remained shallow. Laser peripheral iridotomy was performed in the right eye and surgical peripheral iridectomy was performed in the left eye. After two weeks, vision improved to 20/30 in both eyes with normal intraocular pressure off antiglaucoma medications. Anterior chambers deepened significantly with clear corneas bilaterally. Gonioscopy at this stage showed essentially open angles with appositional closure in superior and temporal quadrants in the right eye and open angles in all four quadrants in the left eye. Posterior segment evaluation revealed normal optic disc in both eyes. Conclusions: Bilateral simultaneous acute angle closure is a rare presentation with very few reported secondary causes. We report a case of bilateral simultaneous angle closure in an adult Nepalese woman without any known secondary cause. The case was successfully managed with laser peripheral iridotomy in the right eye and surgical peripheral iridectomy in the left eye.

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First experience using micropulse cyclophotocoagulation in complex treatment acute angle closure glaucoma

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2021-1-71-74 ◽

2021 ◽

pp. 71-74

Author(s):

V.V. Egorov ◽

◽

A.V. Postupaev ◽

N.V. Postupaeva ◽

A.N. Marchenko ◽

...

Keyword(s):

Intraocular Pressure ◽

Anterior Chamber ◽

Laser System ◽

Corneal Edema ◽

Acute Angle ◽

Angle Closure Glaucoma ◽

Angle Closure ◽

Complex Treatment ◽

Acute Angle Closure ◽

Acute Angle Closure Glaucoma

Purpose. To study effectiveness of micropulse cyclophotocoagulation (MP-CPC) in complex treatment acute angle closure glaucoma (ACG). Material and methods. Dynamic observation of 4 patients with acute ACG was carried out. There was stagnant injection of the conjunctiva, corneal edema, shallow anterior chamber, iris bombe, mydriasis up to 4–6 mm, closed anterior chamber angle in all quadrants. In three cases, the initial lens opacities were determined, in one eye the lens was transparent. Against the background of drug therapy and laser iridectomy, the intraocular pressure (IOP) level reached values from 26 to 33 mm Hg. On days 2–3 after admission to the hospital, all patients underwent MP-CPC using the Cyclo G6 Glaucoma Laser System the MicroPulse P3 glaucoma device (Iridex, USA). Results. The operation and postoperative period were uneventful. All patients had pain relief, inflammatory response was absent. Corneal edema was stopped 1–2 days after surgery. In all eyes, on the first day after the operation, there was significant decrease in IOP level to 14–23 mm Hg. One month after the complex treatment, the IOP level remained stably normal and ranged from 16 to 21 mm Hg in all patients. Increase in visual acuity was noted in all cases. Conclusion. MP-CPC is effective, safe and low-traumatic operation and can be used in complex treatment of patients with an acute ACG. Key words: micropulse cyclophotocoagulation, acute angle closure glaucoma, intraocular pressure.

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