Ocular Side Effects of Prescription Medications

Drug-induced ocular side effects are frequently noted after a drug comes to market. Spontaneous reporting systems can collect data and provide a "signal" that a possible drug-adverse reaction relationship exists. It is many times difficult to collect incidence data and cause-and-effect analysis because this type of spontaneous reporting system is passive. It relies on the reporting physician or patient to provide information, and data are not collected proactively or in a systematic matter. Still, these signals are many times the first evidence available that an adverse reaction is occurring. There are numerous examples throughout ophthalmology whereby spontaneous reports have revealed real ocular side effects. These include topiramate angle-closure glaucoma, bisphosphonate uveitis and scleritis, retinoid-associated pseudotumor cerebri, niacin-induced cystoid macular edema, intraoperative floppy iris syndrome from alpha antagonists, and many other examples. Also, there is now a useful classification system that helps to divide spontaneous reports into categories based upon the completeness of the information. Certain, probable, possible, unlikely, and unclassifiable are all categories that can be applied. This chapter looks at commonly prescribed medications like sildenafil, tamoxifen, amiodarone, topiramate, bisphosphonates, and others and provides an overview of commonly identified adverse drug reactions.