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Author: Admin | 2025-04-28
And is controlled by the sympathetic nervous system. Mydriasis occurs in the dark to help increase sight. Anticholinergic activity leads to mydriasis, while cholinergic activity leads to miosis.1,2 Systemic Drug Therapy Drugs can affect mydriasis and miosis. Atropine is commonly given at ophthalmologist visits to induce mydriasis and cycloplegia. Atropine is extracted from the deadly nightshade plant, Atropa belladonna, and was used historically to induce mydriasis for beauty. Other agents used to induce mydriasis include phenylephrine and cyclopentolate. Use of cholinergic agents such as pilocarpine would cause miosis.1,2 Systemic administration of drugs can affect all structures and functions of the eye. The pharmacologic or pharmacokinetic properties of a drug can cause expected ocular adverse effects, possibly even serving as a marker of toxicity. Both permanent vision loss and temporary visual disturbances are possible. Pharmacists should be aware of common and severe adverse events and the reporting mechanisms. Recommendations for monitoring and management of ocular effects vary in the literature. A number of organizations have published clinical practice guidelines on the monitoring parameters for some of the agents, including the American Optometrist Association (AOA).3 Prescribing information for individual agents should also be consulted for monitoring recommendations. This article will focus on a group of medications that can cause several common and distinct adverse ophthalmic reactions, although it is not a complete compilation of all such agents (TABLE 1). Amiodarone Used for the treatment of various arrhythmias, amiodarone is designated a class III anti-arrhythmic, but exhibits effects of all four classes. Amiodarone has been associated with a range of ocular toxicities, the most common being corneal deposits and colored halos around lights.4 Although rare, optic neuropathy has also been seen with amiodarone therapy. Amiodarone is generally used for long-term therapy for various cardiac arrhythmias. Typical dosing is 200 to 400 mg daily.
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