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This book is intended as a guide to help the clinician determine where a visual problem is a drug-induced ocular side effect. We continually review spontaneous case reports from the National Registry of Drug-Induced Ocular Side Effects, the World Health Organization, the US Food and Drug Administration, and the world literature. We have attempted to classify a suspected adverse event with our impression to causality (i.e. certain, probable, unlikely, conditional/unclassified). This chapter discusses analgesics, narcotic antagonists, and drugs used to treat arthritis including drugs used to treat gout, antirheumatic drugs, mild analgesics, narcotic antagonists, and strong analgesics. more...

This book is intended as a guide to help the clinician determine where a visual problem is a drug-induced ocular side effect. We continually review spontaneous case reports from the National Registry of Drug-Induced Ocular Side Effects, the World Health Organization, the US Food and Drug Administration, and the world literature. We have attempted to classify a suspected adverse event with our impression to causality (i.e. certain, probable, unlikely, conditional/unclassified). This chapter discusses drugs used to treat allergic and neuromuscular disorders including drugs used to treat myasthenia gravis, antihistamines, anti-Parkinsonism drugs, cholinesterase reactivators, and muscle relaxants. more...

This book is intended as a guide to help the clinician determine where a visual problem is a drug-induced ocular side effect. We continually review spontaneous case reports from the National Registry of Drug-Induced Ocular Side Effects, the World Health Organization, the US Food and Drug Administration, and the world literature. We have attempted to classify a suspected adverse event with our impression to causality (i.e. certain, probable, unlikely, conditional/unclassified). This chapter discusses drugs used in the management of human immunodeficiency virus/acquired immunodeficiency syndrome including antiretroviral drugs. more...

This book is intended as a guide to help the clinician determine where a visual problem is a drug-induced ocular side effect. We continually review spontaneous case reports from the National Registry of Drug-Induced Ocular Side Effects, the World Health Organization, the US Food and Drug Administration, and the world literature. We have attempted to classify a suspected adverse event with our impression to causality (i.e. certain, probable, unlikely, conditional/unclassified). This chapter discusses drugs used in anesthesia including adjuncts to anesthesia, general anesthesia, local anesthesia, and therapeutic gases. more...

This book is intended as a guide to help the clinician determine where a visual problem is a drug-induced ocular side effect. We continually review spontaneous case reports from the National Registry of Drug-Induced Ocular Side Effects, the World Health Organization, the Food and Drug Administration, and the world literature. We have attempted to classify a suspected adverse event with our impression to causality (i.e. certain, probable, unlikely, conditional/unclassified). This chapter discusses cardiac, vascular, and renal drugs including drugs used to treat migraine, antianginal drugs, antiarrythmic drugs, antihypertensive drugs, bronchodilators, diuretics, osmotics, peripheral vasodilators, and vasopressors. more...

This book is intended as a guide to help the clinician determine where a visual problem is a drug-induced ocular side effect. We continually review spontaneous case reports from the National Registry of Drug-Induced Ocular Side Effects, the World Health Organization, the US Food and Drug Administration, and the world literature. We have attempted to classify a suspected adverse event with our impression to causality (i.e. certain, probable, unlikely, conditional/unclassified). This chapter discusses drugs affecting the autonomic nervous system including stimulants. more...

This book is intended as a guide to help the clinician determine where a visual problem is a drug-induced ocular side effect. We continually review spontaneous case reports from the National Registry of Drug-Induced Ocular Side Effects, the World Health Organization, the US Food and Drug Administration, and the world literature. We have attempted to classify a suspected adverse event with our impression to causality (i.e. certain, probable, unlikely, conditional/unclassified). This chapter discusses drugs affecting the central nervous system including analeptics, anorexiants, antianxiety drugs, anticonvulsants, antidepressants, anti–multiple sclerosis drugs, antipsychotic drugs, depressants, genitourinary tract drugs, psychedelic drugs, sedatives, and hypnotics. more...

This book is intended as a guide to help the clinician determine where a visual problem is a drug-induced ocular side effect. We continually review spontaneous case reports from the National Registry of Drug-Induced Ocular Side Effects, the World Health Organization, the US Food and Drug Administration, and the world literature. We have attempted to classify a suspected adverse event with our impression to causality (i.e. certain, probable, unlikely, conditional/unclassified). This chapter discusses heavy metal antagonists and miscellaneous drugs including drugs to treat alcoholism, calcium-regulating drugs, chelating drugs, diagnostic aids, immunosuppressants, retinoids, solvents, and vaccines. more...

This book is intended as a guide to help the clinician determine where a visual problem is a drug-induced ocular side effect. We continually review spontaneous case reports from the National Registry of Drug-Induced Ocular Side Effects, the World Health Organization, the Food and Drug Administration, and the world literature. We have attempted to classify a suspected adverse event with our impression to causality (i.e. certain, probable, unlikely, conditional/unclassified). This chapter discusses homeostatic and nutrient drugs including drugs used to treat hyperglycemia. more...

This book is intended as a guide to help the clinician determine where a visual problem is a drug-induced ocular side effect. We continually review spontaneous case reports from the National Registry of Drug-Induced Ocular Side Effects, the World Health Organization, the US Food and Drug Administration, and the world literature. We have attempted to classify a suspected adverse event with our impression to causality (i.e. certain, probable, unlikely, conditional/unclassified). This chapter discusses hormones and drugs affecting hormonal mechanisms including adrenal corticosteroids, androgens, antithyroid drugs, erectile dysfunction drugs, estrogens and progestogens, ovulatory drugs, and thyroid hormones. more...

This book is intended as a guide to help the clinician determine where a visual problem is a drug-induced ocular side effect. We continually review spontaneous case reports from the National Registry of Drug-Induced Ocular Side Effects, the World Health Organization, the US Food and Drug Administration, and the world literature. We have attempted to classify a suspected adverse event with our impression to causality (i.e. certain, probable, unlikely, conditional/unclassified). This chapter discusses drugs affecting blood formation and coagulability including drugs used to treat deficiency anemias, anticoagulants, and blood substitutes. more...

This book is intended as a guide to help the clinician determine where a visual problem is a drug-induced ocular side effect. We continually review spontaneous case reports from the National Registry of Drug-Induced Ocular Side Effects, the World Health Organization, the US Food and Drug Administration, and the world literature. We have attempted to classify a suspected adverse event with our impression to causality (i.e. certain, probable, unlikely, conditional/unclassified). This chapter discusses drugs used in ophthalmology including drugs used to treat age-related macular degeneration, drugs used to treat allergies, drugs used to treat glaucoma, anti-infectives, antiviral drugs, carbonic anhydrase inhibitors, decongestants, miotics, mydriatics and cycloplegics, neurotoxins, ophthalmic dyes, ophthalmic implants and injectable gases, ophthalmic preservatives and antiseptics, proteolytic enzymes, surgical adjuncts, topical local anesthetics, topical ocular nonsteroidal anti-inflammatory drugs, topical osmotic drugs, and viscoelastics. more...

PURPOSE To evaluate a possible association between apremilast and increased tearing. METHODS A retrospective observational case series in which reports from VigiBase, the World Health Organization global database of Individual Case Safety Reports, and the literature involving apremilast were evaluated by the National Registry of Drug-Induced Ocular Side Effects for possible increased tearing. RESULTS A total of 45 cases of possible apremilast-induced increased tearing were identified. All patients were on the standard dose of 30 mg BID. There was no sex difference and ages ranged from 28 to 77 years with an average of 56 years ± 12. Time to onset of the increased tearing ranged from a few days to many months. There were 10 cases of positive dechallenge, 3 cases of positive rechallenge, and 1 case with double-positive rechallenge. In the cases with positive dechallenge and rechallenge, the increased tearing resolved as early as within 2 days after stopping the drug. Most cleared within 2 weeks. One case required 3 months for tearing to return to normal. CONCLUSIONS Based on patterns and positive dechallenge and rechallenge data, apremilast possibly causes increased tearing on rare occasions. more...

The existence of vaccine-associated optic neuritis is essentially based on the temporal relationship between the administration of a vaccine and the development of optic neuritis in patients with no other known aetiologies for infectious or non-infectious inflammation that could account for the optic neuritis. Influenza vaccine (inactivated or live attenuated) is considered to be one of vaccines that could be related to optic neuritis. The authors describe a rare case of bilateral asymmetric optic neuritis with leptomeningeal enhancement on magnetic resonance imaging (MRI) in a previously healthy young woman who received inactivated influenza vaccination 2 weeks before the onset of symptoms. more...

Vaccines have had an enormously positive impact on global health, saving an estimated two to three million lives worldwide each year.1 In 2017 the World Health Organization (WHO) estimated that ove... more...

A retrospective case series was performed in a university setting for all patients with herpes simplex epithelial keratitis who underwent liquid nitrogen cryotherapy from 2012–2015. Outcome measure was clinical evidence of resolution of epithelial keratitis in the cornea with re-epithelialization. All cases of epithelial keratitis showed partial and complete resolution at day 1 and week 1 respectively. Liquid nitrogen cryotherapy is a safe and effective treatment for herpes epithelial keratitis comparable to other published studies. more...

To evaluate possible associations between oral anti-vascular endothelial growth factor (VEGF) drugs and ocular side effects.Spontaneous reports were collected and evaluated by the National Registry of Drug-Induced Ocular Side Effects on the three oral anti-VEGF drugs (pazopanib, sorafenib, and sunitinib) for possible ocular side effects.Reported side effects include blurred or decreased vision (389 cases); periocular or eyelid edema (273 cases); superficial anterior segment toxicity (270 cases); conjunctival, retinal, or vitreous bleeding (77 cases); retinal detachments (RDs) or retinal tears (RTs) (75 cases); extraocular muscle disorders, including ptosis (51 cases); discoloration of eyelashes (36 cases); retinal arterial or venous occlusions (26 cases); optic nerve disorders, including papilledema and ischemic optic neuropathy (21 cases); uveitis (10 cases); and macular edema (7 cases). Spontaneous reports of possible RD or RT have been associated with pazopanib (31 RDs and 12 RTs), sunitinib (24 RDs and 0 RT), and sorafenib (7 RDs and 2 RTs).Oral anti-VEGF drugs can cause superficial anterior segment side effects. Pazopanib has been reported to be possibly linked to RDs and RTs. This study suggests that sorafenib and sunitinib are suspected as well. RDs were seldom differentiated into rhegmatogenous retinal detachments (RRDs) or non-RRDs. The association of oral anti-VEGF drugs with RRD and RT are unclassified although this suggests a "signal" requiring further study. The association of oral anti-VEGF drugs with serous retinal detachments, while rare, is plausible. Patients on this class of drugs should be instructed to seek immediate ophthalmic consultation if retinal symptoms occur. more...

Purpose: To report a possible association between human papilloma virus (HPV) vaccination and uveitis. Methods: Spontaneous reports from the National Registry of Drug-Induced Ocular Side effects, World Health Organization and Food and Drug Administration were collected on uveitis associated with human papilloma virus vaccination. A MEDLINE search was performed using keywords “uveitis,” “iritis,” “iridocyclitis,” “human papilloma virus,” “Cervarix”, and “Gardasil.” Main Outcome Measures: Data garnered from spontaneous reports included the age, gender, adverse drug reaction (ADR), date of administration, concomitant administration of other vaccinations, time until onset of ADR, other systemic reactions, and dechallenge and rechallenge data. Results: A total of 24 case reports of uveitis associated with human papilloma virus vaccination were identified, all cases were female, and the median age was 17. Median time from HPV vaccination to reported ADR was 30 days (range 0-476 days). Discussion: According to World Health Organization criteria, the relationship between human papilloma virus vaccination and uveitis is “possible.” Causality assessments are based on the time relationship of drug administration, uveitis development and re-challenge data. Conclusions: Clinicians should be aware of a possible bilateral uveitis and papillitis following HPV vaccination. more...

Fungal keratitis is a leading cause of ocular morbidity worldwide. Globally, there has been a steady increase in the prevalence of fungal keratitis, yet the management of disease continues to be a challenge. This review will focus on the epidemiology of fungal keratitis on a global scale, as well as a review of the literature on the risk factors associated with the increasing trend of infection including ocular trauma, climate, contact lens use, ocular surgery, ocular surface disease, and systemic diseases. This review will also briefly cover the clinical presentation, diagnosis, and treatment of fungal infections. more...

Title: Investigating Risk Factors for Cataract Using the Cerner Health Facts® Database Background: A retrospective study was performed using the Cerner Health Facts® database, a HIPAA compliant and deidentified database, to evaluate risk factors associated with cataract. Methods and Findings: Using ICD-9 codes, a study group population was determined by selecting all patients in the database who visited the eye clinic. A data-driven approach was used to select multiple variables and odds ratio analysis was performed to determine the association of the risk factors with cataract formation. Odds ratio analysis indicated that 7 variables out of 18 were at a 20% or higher odds for developing of cataract. These include gentamicin, hypertension, lipid metabolism disorder, obesity, steroids and type-two diabetes and lacrimal disorder. Conclusion: This is the first study to show a link between lacrimal disorders and the development of cataract. more...

Cryogens have been used to freeze living tissue for the purpose of treating benign and malignant lesions. Within the last century, ophthalmologists have found cryotherapy to be useful in treating a variety of ocular pathologies. Here, we review the history of cryotherapy, its introduction to the field of ophthalmology, its proposed mechanism of action, and its current applications in treating surface and intraocular eye disease. more...

All of the widely administered vaccines have been reported to cause uveitis. The ocular inflammation is usually temporary and resolves with topical ocular steroids. During a 26-year period, a total of 289 cases of vaccine-associated uveitis were reported to three adverse reaction reporting databases. Hepatitis B vaccine, either alone or administered with other vaccines, appears to be the leading offender. Clinicians are encouraged to report cases of vaccine- or drug-associated ocular adverse reactions to www.eyedrugregistry.com. more...

Purpose To demonstrate feasibility and present postoperative outcomes for femtosecond laser-assisted keratoplasty (FLAK) in the setting of previous failed conventional penetrating keratoplasty (PK) and previous open-globe trauma with corneal laceration. Methods In this retrospective case series, data were collected for 12 consecutive patients at the Casey Eye Institute (Oregon Health and Science University, Portland, OR) with the primary diagnosis of either failed PK or open-globe trauma with corneal laceration that underwent zigzag incision FLAK. Outcome measures included topographic astigmatism, best spectacle-corrected visual acuity, uncorrected visual acuity, pinhole visual acuity, intraocular pressure, and timing of selective suture removal (or adjustment) over various follow-up intervals up to 18 months postoperatively. Results Mean follow-up was 10.42 months. Mean postoperative topographic astigmatism ranged between 3.56 and 6.81 diopters (D). Mean best spectacle-corrected visual acuity (BSCVA) in logarithm of minimal angle of resolution (logMAR) equivalents ranged between 0.18 and 0.61 as compared with 1.28 for preoperative BSCVA (P = 0.0064). Thirty-three percent (4 of 12) of patients had significantly increased intraocular pressure develop during the first year of follow-up that required glaucoma therapy. No adverse events or complications occurred as a result of either the femtosecond laser procedure itself or during the transportation of the patient from the laser suite to the operating room. Conclusions FLAK is a feasible transplantation technique in the setting of previous failed PK and open-globe trauma with corneal laceration. Significant globe pressure associated with laser applanation did not cause rupture of old corneal wounds among our case series. Postoperative astigmatism is within previous reported limits in the literature under varying suturing techniques. Development of ocular hypertension within 1 year of follow-up was comparable with historically reported rates for PK in the setting of previous trauma and failed grafts. more...

Purpose To report a possible association between fluoroquinolones and diplopia. Design Database study. Participants A total of 171 subjects were studied. Methods Spontaneous reports from the National Registry of Drug-Induced Ocular Side Effects, World Health Organization, and Food and Drug Administration were collected on fluoroquinolones and diplopia. Main Outcome Measures Data garnered from the spontaneous reports include the type of fluoroquinolone, age, gender, adverse drug reaction (ADR), dosage, duration of therapy until onset of ADR, concomitant drugs, other systemic disease, and dechallenge and rechallenge data. Results A total of 171 case reports of diplopia associated with fluoroquinolones were reported, including 76 men, 91 women, and 4 case reports in which the gender was not specified. The median age was 51.6 years. Dosage varied between the different fluoroquinolone drugs, with the median dosage within the range recommended in the package insert for each different fluoroquinolone. Median time from beginning of therapy to appearance of the ADR was 9.6 days (range 1 day to 5 months). Seventeen subjects also had concomitant tendinitis, 49 patients were 60 years or older, 1 patient had renal cysts, and 4 patients were taking systemic anti-inflammatory steroids. There were 53 positive dechallenge and 5 positive rechallenge case reports. Conclusions According to World Health Organization criteria, the relationship between fluoroquinolone therapy and diplopia is "possible." This causality assessment is based on the time relationship of drug administration and ADR development, the multiple positive dechallenge and rechallenge reports, and the plausible mechanism by which diplopia could occur: possible tendinitis of the extraocular muscles. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references. more...

Purpose : To investigate a suspected relationship between central serous chorioretinopathy (CSC) and sildenafil therapy. Methods : For this retrospective, observational case series, the authors reviewed over 1,500 case reports of sildenafil-associated ocular side effects from the postmarketing surveillance databases of the Food and Drug Administration (FDA), the World Health Organization (WHO), and the National Registry of Drug-Induced Ocular Side Effects. They also performed a Medline literature search for "retinopathy, retinal edema, macular edema" (terms associated with CSC) and "sildenafil." They identified 11 cases of CSC in men taking sildenafil. Results : In 8 of 11 cases, patients stopped sildenafil therapy when CSC occurred. In 6 of these 8 cases, patients' vision improved after sildenafil cessation. In 3 cases, effects recurred when patients resumed sildenafil therapy, but stopping therapy was not associated with improvement of CSC in every case. Two patients continued to experience CSC after sildenafil cessation. Conclusion : Practitioners who see patients with refractory CSC should consider recommending cessation of sildenafil therapy; however, because of the cyclic nature of CSC, a causal relationship has not yet been established. Additional possible case reports can be sent to the National Registry of Drug-Induced Ocular Side Effects, the FDA, the WHO, or the manufacturer. more...

This article reviews several retrospective case series and reported adverse events regarding common ocular adverse effects related to systemic therapy. It is not intended as a comprehensive summary of these well described adverse drug reactions, nor is it intended to cover the complete spectrum of all ocular adverse effects of systemic therapy. Many systemic drugs may produce ocular toxicity, including bisphosphonates, topiramate, vigabatrin, isotretinoin and other retinoids, amiodarone, ethambutol, chloroquine and hydroxychloroquine, tamoxifen, quetiapine, cyclo-oxygenase (COX)-2 inhibitors, erectile dysfunction agents and some herbal medications. For this review, the certainty of the adverse effect profile of each medication was evaluated according to the WHO Causality Assessment Guide. A certain relationship has been established for pamidronate and alendronate as causes of scleritis, uveitis, conjunctivitis and blurred vision. Topiramate has been established as adversely causing symptoms consistent with acute angle-closure glaucoma, typically bilateral. Vigabatrin has been shown to cause bilateral irreversible visual field defects attributed to underlying medication-induced retinal pathology. Isotretinoin should be considered in the differential diagnosis of any patient with pseudotumour cerebri. Patients taking amiodarone and hydroxychloroquine should be monitored and screened regularly for development of optic neuropathy and maculopathy, respectively. Sildenafil has been reported to cause several changes in visual perception and is a possible, not yet certain, cause of anterior ischaemic optic neuropathy. Patients taking tamoxifen should also be monitored for development of dose-dependent maculopathy and decreased colour vision. COX-2 inhibitors should be included in the differential diagnosis of reversible conjunctivitis. Several herbal medications including canthaxanthine, chamomile, datura, Echinacea purpurea, Ginkgo biloba and liquorice have also been associated with several ocular adverse effects. It is the role of all healthcare professionals to detect, treat and educate the public about adverse reactions to medications as they are an important health problem. more...

Importance Spontaneous reports to the National Registry of Drug-Induced Ocular Side Effects and case reports in the literature suggest an association between bortezomib use and chalazia. Observations To our knowledge, there have been 24 reports of bortezomib-associated chalazia. Fourteen reports were collected from the National Registry of Drug-Induced Ocular Side Effects. These reports originated at the US Food and Drug Administration’s Adverse Event Reporting System or at the World Health Organization’s Uppsala Monitoring Centre. An additional 10 case reports were found in the literature. The mean age of the 24 patients was 61 years (age range, 37-79 years), 8 were female and 11 were male (the sex was unknown in 5), and the mean duration of bortezomib therapy before the onset of chalazia was slightly more than 3 months (range, 26-428 days; mean, 98 days). Chalazia were usually multiple and involved the upper eyelid. Recommendations for the bortezomib dosages were within the package insert. Most patients were receiving multiple medications. There were 8 positive dechallenge case reports and 3 positive rechallenge case reports. Conclusions and Relevance Using the World Health Organization’s classification for adverse drug reactions, the association between bortezomib use and chalazia is classified as possible. This conclusion is based on the finding that chalazia improved or resolved in most patients when bortezomib was discontinued, the temporal relationship between initial administration of bortezomib and chalazia onset, and the positive dechallenge and rechallenge data. more...

Purpose To review what is known about the adverse effects on the cornea from various classes of medications. New data from previously unreported cases of drug-related corneal toxicity are included. Methods Data are garnered from a Medline literature review and from case reports collected by the World Health Organization, the Food and Drug Administration, and the National Registry of Drug-Induced Ocular Side Effects. Results Aminoglycosides, bisphosphonates, chemotherapeutic medications, cyclooxygenase-2 inhibitors, fluoroquinolones, glaucoma eye drops, topical iodine, nonsteroidal anti-inflammatory eye drops, preservatives in eye drops, retinoids, topical anesthetics, topical steroids, and some herbal medications can cause corneal toxicity in some patients. Conclusion Ophthalmologists need to be aware of potential corneal toxicities that can arise from commonly prescribed medications. more...

Ethambutol optic neuropathy is a well-recognised adverse ocular event in patients who receive ethambutol for the treatment of mycobacterial infections. Much has been published on this condition; however, understanding of patient outcomes and the mechanism by which ethambutol optic neuropathy occurs, as well as data published in textbooks and reference books, tend to lag behind what is currently known. The purpose of this article is to update the clinician on what is currently accepted in regards to the clinical presentation of ethambutol optic neuropathy and what type of eye care should be provided to patients treated with this medication. In addition, new treatment recommendations are suggested to assist clinicians in complying with currently accepted standards of care. more...

Purpose To review the more significant herbal and nutritional agents of clinical importance to ophthalmologists and describe the ocular side effects for each. World Health Organization (WHO) classification and guidelines for clinicians are provided. Design Retrospective observational case series. Methods A retrospective observational case series of reports of ocular side effects or systemic side effects from medications used for the eye from herbal medicines and nutritional supplements. Cases were collected from spontaneous reports submitted to the WHO, the Food and Drug Administration, and the National Registry of Drug-Induced Ocular Side Effects. A review of the world's literature was performed to obtain additional case reports and insight into adverse ocular reactions. Data were collected on age, gender, duration of therapy, concomitant medications, dosage, and dechallenge and rechallenge results. Results The National Registry of Drug-Induced Ocular Side Effects received 263 spontaneous reports, in addition to 60 case reports from the literature. Canthaxanthine, chamomile, Datura, Echinacea purpurea , Ginkgo biloba , licorice, niacin, and vitamin A are all associated with clinically significant ocular side effects. Conclusion Herbal medicines and nutritional supplements can cause ocular side effects. Clinicians need to recognize these adverse events, because a large segment of the population uses them, many times without the treating physician's knowledge. more...

Purpose To report recent ocular adverse drug reactions identified by the National Registry of Drug-Induced Ocular Side Effects. Methods Case reports from the National Registry and the World Health Organization were collected and adverse drug reactions categorized as follows: certain, probable/likely, possible, unlikely, and conditional/unclassifiable. Results Bisphosphonates are associated with ocular inflammation, including the first reports of drug-related scleritis. Topiramate is shown to cause angle-closure glaucoma. Cetirizine can cause an oculogyric crisis, and there is strong evidence retinoids cause intracranial hypertension. Conclusion Recent reports to the National Registry have led to identification of new ocular adverse drug reactions. more...

To assess the efficacy of using a bandage contact lens (BCL) for 3 months for recurrent corneal erosions (RCE) to facilitate epithelial adhesion.Retrospective study of patients presented to the Casey Eye Institute (Portland, OR) with RCE after failing at least 6 weeks of medical lubrication therapy. Subjects were treated with an extended-wear BCL for 3 months and then followed for approximately 1 year. The main outcome measure was recurrence of RCE. Best-corrected visual acuity was measured before and after BCL therapy.From the 12 patients studied, 9 (75%) had no recurrence of RCE after approximately 1 year of follow-up. Three subjects had subjective complaints of recurrent erosion during the follow-up period with 1 of these 3 subjects having objective findings of a recurrent erosion.Three-month BCL treatment is a safe and effective medical therapy with a relatively low recurrence rate of RCE. more...

Drug-induced uveitis is a relatively rare occurrence. For example, the patient database at the tertiary referral Uveitis Clinic at the Casey Eye Institute, Oregon Health Sciences University records an incidence of less than 0.5%. Despite this, the frequency of uveitis secondary to rifabutin therapy in AIDS patients has brought greater recognition to the potential role of medications as a cause of intraocular inflammation. A brief review of uveitis including its classification, causes, symptoms and signs is presented along with a review of systemic medications associated with uveitis. These medications include cidofovir, cobalt, diethylcarbamazepine, pamidronic acid (disodium pamidronate), interleukin-3 and interleukin-6, oral contraceptives, quinidine, rifabutin, streptokinase and sulfonamides. Other systemic medications may cause uveitis. Topical ocular medications such as beta-blockers and corticosteroids as well as other topical ocular medications have been associated with uveitis. Cidofovir, pamidronic acid, sulfonamides, rifabutin and topical metipranolol can 'probably' cause uveitis. The remainder of the medications discussed have a 'possible' cause-and-effect relationship with uveitis. Treatment begins with recognition of a drug-related event and usually subsequent avoidance of the drug. Therapy depends on the severity and likelihood of the reaction. Drug-induced uveitis is almost always reversible within weeks of discontinuation of the drug and treatment of the inflammation. more...

Topical ocular anesthetics are generally well tolerated in clinical settings but have great potential for abuse if used by patients at home. This abuse can lead to significant ocular complications. Topical ocular anesthetic abuse can lead to superficial punctate keratitis, persistent epithelial defects, stromal/ring infiltrates, corneal edema, endothelial damage and ocular inflammation, even when used in a dilute concentration. Patient characteristics may include a healthcare association and/or psychiatric illness. In these instances, patients often do not admit to anesthetic use and are often initially treated for acanthamoeba keratitis. Local anesthetics are thought to cause direct toxicity to the corneal epithelium, stroma and endothelium. This in turn may lead to release of antigens and from there an inflammatory response in the form of infiltrate and edema. It is thought that preservatives in anesthetics may play a further role in toxicity.The authors provide a brief history on topical ocular anesthetics and review the most recent literature on reported ocular toxicities of topical anesthetics.Practitioners must maintain high suspicion for topical ocular anesthetic abuse to identify it early. Topical ocular anesthetic abuse is often misdiagnosed as acanthamoeba keratitis. Early identification is one of the most important factors for a successful outcome. It is also imperative to give proper alternative pain control to avoid topical anesthetic abuse. more...

The objective of this review was to collect reports of keratitis in association with herpes zoster virus (HZV) or varicella zoster virus (VZV) vaccines. HZV vaccination is intended for at-risk adult populations and VZV vaccination is intended for all pediatric patients. We reviewed the literature and reports of keratitis in association with herpes zoster or varicella vaccine from the National Registry of Drug-Induced Ocular Side Effects and the World Health Organization. Twenty-four cases of unilateral keratitis in association with VZV vaccines were collected from the adverse reaction databases and literature. In most cases, the onset of keratitis occurred within days of vaccination and resolved with topical steroid eye drops and oral acyclovir. Data suggest that keratitis in association with herpes zoster or varicella vaccine is rare, is usually self-limited or resolves with treatment. The mechanism may be the persistence of viral antigens in the cornea after VZV vaccination or herpes zoster ophthalmicus. This reaction is probable, given the plausible biological mechanism, the temporal relationship between vaccination and keratitis, and overall patterns of presentation after vaccination. more...

Purpose To evaluate the association between intracranial hypertension (IH) and isotretinoin use. Design Observational case series. Methods In this retrospective study, approximately 1950 case reports of adverse ocular side effects related to isotretinoin were received from spontaneous reporting systems. Reports were evaluated as to the occurrence of IH with isotretinoin use. A survey was mailed to all members of the North American Neuro-ophthalmology Society soliciting their opinions on whether isotretinoin caused IH. Results One hundred seventy-nine reports of IH were associated with isotretinoin use. The mean time from drug exposure to IH diagnosis was 2.3 months. There were 6 cases of positive rechallenge; 5 new cases are reported here, along with 1 previously published report. Of neuro-ophthalmologists surveyed (62% response rate), 6% believed an association between IH and isotretinoin use was certain; 32%, probable; 52%, possible; and 10%, unlikely. Twelve respondents (4%) had personally seen one or more cases of positive rechallenge with isotretinoin causing IH. Conclusions Based on the number and pattern of rapid IH onsets after isotretinoin exposure and the 6 cases of positive rechallenge, along with the probable similarity in metabolic pathways of this agent and vitamin A (a known cause of IH), it seems certain that there is a direct correlation between IH and isotretinoin use. more...