Lloyd Michael J, Fraunfelder Frederick W
Casey Eye Institute, Portland, Oregon, USA.
Drugs Today (Barc). 2007 Nov;43(11):827-36. doi: 10.1358/dot.2007.43.11.1157621.
The term optic neuropathy is used to describe optic nerve damage caused by any of four main etiologies: ischemic, hereditary, nutritional and toxic. Ischemic and hereditary optic neuropathies produce profound and often irreversible vision loss. Proper diagnosis of nutritional or toxic optic neuropathies provides the opportunity for potential treatment and hope of restored visual function. Toxic optic neuropathy may occur from exposure or ingestion of non-medicinal compounds such as methanol, carbon monoxide, toluene and ethylene glycol or may be the result of an adverse drug reaction. Many drugs have been associated with optic nerve disease (Table I). This article describes agents on which the most data is available, and which most frequently cause adverse reactions. Amiodarone, ethambutol, linezolid and sildenafil are commonly prescribed medications. Since most practitioners frequently encounter patients taking one or more of these drugs, awareness of optic neuropathy risk is essential for timely referral and accurate diagnosis. The most important aspect of treatment is identification of the offending agent and prompt drug withdrawal. Where there is consensus, we will present guidelines on screening for and managing the various drug-induced optic neuropathies.
术语“视神经病变”用于描述由四种主要病因中的任何一种引起的视神经损伤：缺血性、遗传性、营养性和中毒性。缺血性和遗传性视神经病变会导致严重且通常不可逆的视力丧失。正确诊断营养性或中毒性视神经病变为潜在治疗提供了机会以及恢复视功能的希望。中毒性视神经病变可能因接触或摄入甲醇、一氧化碳、甲苯和乙二醇等非药用化合物而发生，或者可能是药物不良反应的结果。许多药物都与视神经疾病有关（表I）。本文描述了有最多数据可用且最常引起不良反应的药物。胺碘酮、乙胺丁醇、利奈唑胺和西地那非是常用药物。由于大多数从业者经常遇到服用这些药物中的一种或多种的患者，因此了解视神经病变风险对于及时转诊和准确诊断至关重要。治疗的最重要方面是识别致病药物并立即停药。在有共识的情况下，我们将提出关于各种药物性视神经病变的筛查和管理指南。
