Jaanus S D
Optom Clin. 1992;2(4):73-96.
Numerous systemic drugs produce adverse effects that involve the eye. Pigmentary inclusions of the lids or conjunctivae or both may be caused by a variety of drugs, including amiodarone, chlorpromazine, and gold salts, while conjunctivitis and blepharoconjunctivitis have been associated with isotretinoin, sulfonamides, salicylates, and antineoplastic agents. Dry eye complaints may be caused by antihistamines, beta-receptor blocking agents prescribed for cardiovascular problems, antianxiety agents, and tricyclic antidepressants. Several drugs have been well documented as causes of keratopathies and/or lenticular deposits, including chloroquine and hydroxychloroquine, chlorpromazine, gold salts, systemic corticosteroids, nonsteroidal antiinflammatory drugs, and the antiarrhythmic agent amiodarone. Visual acuity may be decreased by transient changes in refractive error caused by sulfonamides, the antifungal agent metronidazole, thiazide diuretics, and carbonic anhydrase inhibitors. Dilation of the pupil may be caused by anticholinergic drugs, antihistamines, antidepressant agents, and central nervous system stimulants such as cocaine, methylphenidate, and amphetamines. Nystagmus, diplopia, and extraocular muscle palsies have been associated with central nervous system depressants, antihistamines, barbiturates, and elevated blood ethanol concentrations. Intraocular pressure can be elevated in susceptible individuals by long-term use of topical or systemic corticosteroids. Numerous drugs have been associated with retinal toxicity, including chloroquine and hydroxychloroquine, thioridazine, tamoxifen, and talc, which may embolize to the retinal circulation when administered by long-term drug abusers. The antituberculosis agents ethambutol and isoniazid have been implicated as causes of reduced acuity, visual field defects, and disturbances of color vision. Optic neuritis and retrobulbar neuritis may result from the use of chloramphenicol. This paper describes these and other adverse ocular effects that may be encountered when examining patients who are taking systemic drugs.
许多全身性药物会产生累及眼睛的不良反应。眼睑或结膜或两者的色素沉着可能由多种药物引起，包括胺碘酮、氯丙嗪和金盐，而异维甲酸、磺胺类药物、水杨酸盐和抗肿瘤药物则与结膜炎和睑结膜炎有关。干眼症可能由抗组胺药、用于心血管问题的β受体阻滞剂、抗焦虑药和三环类抗抑郁药引起。几种药物已被充分证明是角膜病变和/或晶状体沉积物的病因，包括氯喹和羟氯喹、氯丙嗪、金盐、全身性皮质类固醇、非甾体抗炎药和抗心律失常药胺碘酮。磺胺类药物、抗真菌药甲硝唑、噻嗪类利尿剂和碳酸酐酶抑制剂引起的屈光不正短暂变化可能会导致视力下降。瞳孔散大可能由抗胆碱能药物、抗组胺药、抗抑郁药以及中枢神经系统兴奋剂如可卡因、哌醋甲酯和苯丙胺引起。眼球震颤、复视和眼外肌麻痹与中枢神经系统抑制剂、抗组胺药、巴比妥类药物以及血液乙醇浓度升高有关。长期使用局部或全身性皮质类固醇可使易感个体的眼压升高。许多药物与视网膜毒性有关，包括氯喹和羟氯喹、硫利达嗪、他莫昔芬和滑石粉，长期药物滥用者使用滑石粉时可能会栓塞到视网膜循环中。抗结核药物乙胺丁醇和异烟肼被认为是导致视力下降、视野缺损和色觉障碍的原因。使用氯霉素可能会导致视神经炎和球后视神经炎。本文描述了在检查服用全身性药物的患者时可能遇到的这些及其他不良眼部影响。
