When your doctor writes you a prescription for, say, a blood pressure medication, a drug for prostate problems or even a nasal spray for your allergies, you probably don’t think about your eyes. But you should.
Medications that treat a wide variety of medical conditions can lead to blurry vision, cataracts, glaucoma and even blindness.
To help protect yourself, you should get a baseline eye exam before taking one of the medications below and schedule follow-ups at the frequency recommended by your ophthalmologist (typically annually or every four to six months, depending on the drug). Important: Be sure to report any eye-related side effects, including distorted vision or eye pain, to your ophthalmologist.
Hydroxychloroquine (Plaquenil). This drug, which has been studied as a treatment for COVID-19, was originally used to treat malaria but now is widely prescribed for inflammatory diseases such as lupus and rheumatoid arthritis. When used for five or more years, hydroxychloroquine can cause damage to the macula, the central part of the retina where light-sensitive nerve cells are located in the back of your eye.
This side effect is insidious because symptoms usually don’t occur until there’s retinal damage. Even if the drug is discontinued, the impairment may be irreversible. In a recent study in Arthritis & Rheumatology, nearly 8% of lupus patients who had the highest average blood levels of hydroxychloroquine developed maculopathy, an eye disease that can result in complete loss of central vision.
Self-defense: Get a baseline eye exam by an ophthalmologist followed by annual exams…and exams as needed after five years of hydroxychloroquine use. The goal is to remain on a weight-based dosage of less than 5 mg/kg per day.
Steroid nasal sprays. Like oral and topical corticosteroids, steroid nasal sprays, such as fluticasone (Flonase) and triamcinolone (Nasacort), can increase your risk for cataracts and glaucoma. Widely used for allergies, these sprays can be problematic because they are available in prescription and over-the-counter (OTC) versions—and both types carry similar risks for eye damage.
Self-defense: Do not use an OTC steroid nasal spray unless you are advised to do so by your physician. If your doctor does recommend it, try to use the medication sparingly and ask about alternative treatments that do not contain steroids. Daily nasal salt rinses can be safer and cause fewer side effects.
Digoxin (Lanoxin). This common heart medication can cause blurry vision and halos around bright objects. These drug-induced visual changes usually mean that you have too much in your system, called digoxin toxicity.
Self-defense: If you experience eye symptoms while taking digoxin, ask your doctor to reduce the dosage. Do not make changes to your medication without consulting your physician.
Blood pressure medications. When taking these drugs, blood pressure can sometimes fall too low, making you feel light-headed or dizzy. If blood pressure is consistently too low, damage to the optic nerve, called optic neuropathy, can occur due to a decreased blood supply.
Self-defense: To decrease your chances of developing this serious side effect, ask your physician if it is OK to avoid taking your blood pressure medication at night, when blood pressure naturally drops during sleep. Do not make any medication changes without first consulting your doctor.
Bisphosphonate drugs. Alendronate (Fosamax) and other drugs within this class are used to help prevent osteoporosis. In rare cases, a bisphosphonate can cause inflammation of the eye called uveitis. Symptoms include eye pain, redness and blurry vision. The inflammation stops when you discontinue the drug, but always check first with your doctor.
Self-defense: If you have eye symptoms while taking a bisphosphonate, ask your physician about the osteoporosis drug denosumab (Prolia, Xgeva), which may be safer for your eyes.
Tamoxifen (Nolvadex). Many women with breast cancer are treated with this drug. It can be harmful to the retina, leading to distorted or blurry vision as well as cataracts. The effects are cumulative—risk for cataracts, for example, increases after using the medication for about five years.
Self-defense: If your doctor recommends this medication to reduce your risk for recurrent and/or worsening breast cancer, be sure to get yearly eye exams from an ophthalmologist.
Topiramate (Topamax). Used to treat seizures and migraines, this drug can increase risk for a serious eye disease called angle-closure glaucoma. This condition results from a mainly inherited disorder, known as “narrow angle” eyes, that crowds the drainage structure of the eye, resulting in elevated eye pressure—a hallmark of glaucoma. Risk factors for narrow angle eyes include a family history of glaucoma and being farsighted. Only an eye exam, with a test called gonioscopy, can detect narrow angle eyes.
Symptoms of angle-closure glaucoma may include eye pain and headache, typically within a month of starting the drug. In severe cases, topiramate-induced angle-closure glaucoma triggers sudden blindness that is reversible if treated immediately.
Self-defense: If you develop eye symptoms while taking topiramate, see an ophthalmologist right away. If you are unable to be seen by your ophthalmologist, go to an emergency room with ophthalmologists on staff who can treat you urgently. Safer alternatives are available to treat migraines—consult your doctor for recommendations.
Tamsulosin (Flomax). Commonly used by men with benign prostate enlargement, tamsulosin can weaken the iris, the colored part of the eye. When this occurs, a “floppy iris” can limit dilation during eye exams and eye surgery, which may prevent the pupil from staying open during cataract surgery. This can lead to complications, such as incomplete removal of the cataract and/or permanent damage to the iris with a permanent misshapen pupil. Women also may take tamsulosin for bladder problems and kidney stones.
Self-defense: If you have ever taken this drug, tell your eye doctor before having any eye surgery, including cataract removal. The effects of tamsulosin can linger for years. If the surgeon knows you’ve taken this drug, steps can be taken to greatly improve the odds of a successful eye surgery. There are alternatives to tamsulosin—discuss this with your doctor or urologist.
Erectile dysfunction (ED) drugs. Because they divert blood flow away from the head and eye to the genital area, all ED medications, including sildenafil (Viagra), can cause blurry
vision, light sensitivity and a blue-green tinge to your vision. ED drugs also increase risk for optic nerve damage called ischemic optic neuropathy, which can, in rare cases, cause sudden blindness.
Self-defense: If you suffer a sudden loss of vision while taking an ED drug, see an ophthalmologist immediately.
The American Academy of Ophthalmology recommends a baseline eye exam for everyone at age 40—sooner if you have diabetes, high blood pressure or a family history of eye disease. Your ophthalmologist will tell you how often to repeat your eye exams. Important: If you have glaucoma or narrow angle eyes (described earlier), always read drug warning labels, and don’t take any prescription or OTC medication without checking with your doctor. Glaucoma warnings are found on many drugs, including those that treat urinary incontinence, acid reflux or nausea, depression and anxiety.
To find out if a drug you’re taking has eye-related side effects, go to DailyMed.nlm.nih.gov, search the medication by name and click on “adverse reactions.”
