Ocular Manifestations of Digitalis Toxicity

Robertson, Dennis M.

doi:10.1001/archopht.1966.03850010642004

Cited by 39 publications

(7 citation statements)

References 24 publications

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“…Digoxin and related cardiac glycosides are capable of producing a variety of ocular adverse effects including dazzle, visual hallucinations, photopsia, photophobia, reduced visual acuity, altered colour perception and even temporary blindness (Robertson et al 1966). Blurred vision and altered colour perception (particularly xanthopsia) occur most frequently.…”

Section: Digoxinmentioning

confidence: 99%

Clinically Important Ocular Reactions to Systemic Drug Therapy

Rennie

1993

Drug Safety

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Many systemically administered drugs produce ocular adverse effects. Fortunately, relatively few are capable of causing significant, irreversible visual impairment. It is the responsibility of every clinician when prescribing systemic therapeutic agents to be aware of potential adverse ocular reactions, to appreciate their significance, and to inform the patient of the potential risks of treatment. In instances where serious adverse reactions relate to the cumulative effects of prolonged treatment, it is the responsibility of the prescribing physician to institute appropriate methods of visual screening. In this respect, it is most important to obtain the necessary individual baseline measurements before treatment is commenced. Chloroquine retinopathy is probably the most feared of all adverse ocular reactions to systemic drug therapy. However, it occurs only rarely if the daily dosage of chloroquine does not exceed 250mg. Regular screening using automated perimetry is mandatory if prolonged therapy is contemplated. Amiodarone almost inevitably produces corneal deposits. These rarely produce symptoms, and resolve upon withdrawal of the drug. Optic neuropathy has recently been described with amiodarone. Systemic anticoagulant therapy may be associated with intraocular hemorrhage in patients with pre-existing disciform macular degeneration, and such agents should be used with caution in affected individuals. Systemic corticosteroids produce posterior subcapsular cataracts in susceptible individuals which may profoundly affect visual acuity. Although elevated intraocular pressure may also result from systemic therapy, the relationship between the pressure rise and development of glaucomatous changes remains unclear. Ethambutol may produce optic neuropathy if the daily dosage exceeds 15 mg/kg. The changes are usually reversible within a few weeks of stopping treatment. High doses of tamoxifen may produce a maculopathy with loss of visual acuity, if given for prolonged periods. The risk must be weighed against the benefits of treatment. Patients receiving more than 800 mg/day of thioridazine have developed retinopathy, which is usually reversible if detected early enough. Tricyclic antidepressants and other agents with anticholinergic properties may cause disturbances of accommodation and pupillary dilatation. The latter may rarely precipitate acute angle closure glaucoma in susceptible individuals.

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Section: Digoxinmentioning

confidence: 99%

Clinically Important Ocular Reactions to Systemic Drug Therapy

Rennie

1993

Drug Safety

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“…Visual disturbances are the most common symptoms of digitalis toxicity and often the initial signs [72,73,74]. A common ocular complaint is xanthopsia, but blurring, central scotomas, photopsia and altered color perception have also been reported [72,73,75].…”

Section: Digoxin Retinopathymentioning

confidence: 99%

The Role of Multifocal Electroretinography in the Assessment of Drug-Induced Retinopathy: A Review of the Literature

Dettoraki

Moschos²

2016

Ophthalmic Res

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Multifocal electroretinography (mfERG) is an objective, noninvasive examination for the assessment of visual function. It enables the stimulation of multiple retinal areas simultaneously and recording of each response independently, providing a topographic measure of retinal electrophysiological activity in the central 40-50° of the retina. A clinical application of mfERG represents the assessment of retinal toxicity associated with systemic medications. Drug-induced retinopathy represents a disease that, although not common, requires early recognition: if not detected early, it may progress and cause irreversible retinal dysfunction with subsequent visual impairment. This review aims to evaluate the use of mfERG in the assessment of retinal dysfunction associated with various systemic pharmacological agents based on the currently available literature. The most commonly recognized systemic medications affecting retinal function are included, such as chloroquine and hydroxychloroquine, vigabatrin, deferoxamine, ethambutol, interferon-α, tamoxifen, digoxin, sildenafil, canthaxanthin, amiodarone and nefazodone. The role of mfERG in the early diagnosis of retinal toxicity and the evaluation of disease severity is reviewed, as well as its clinical value in monitoring disease progression or recovery after drug cessation.

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“…49 It is curious that more recent reviews50 of heatstroke do not mention chro matopsia; perhaps the syndrome is included under delirium or goes unreported because of the stigma attached to admitting to hallucinations. 22 Duke-Elder19 and CarrollS 1 were of the opinion that the visual disturbances due to digitalis intoxication, and some other chemi cally invoked chromatopsias, are actually hal lucinations, i.e. due to central function impairment caused by the drug.…”

Section: Absinthementioning

confidence: 99%

Xanthopsia and van Gogh's yellow palette

Arnold

Loftus

1991

Eye

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A survey of van Gogh's work from 1886 to 1890 indicated that paintings with a yellow dominance were numerous, episodic, and multi-regional. His underlying illness, by his own admission, affected his life and work; furthermore, episodes of malnutrition, substance abuse, environmental exposure, and drug experimentation (all evident from correspondence) exacerbated his condition. Accordingly, we reviewed plausible agents that might have modified the artist's colour perception. Xanthopsia due to overdosage of digitalis or santonin is well documented elsewhere, but evidence of useage of either drug by van Gogh cannot be substantiated. It is unlikely that ageing of the human lens was an influence because of the artist's youth. Sunstroke is too restrictive to fit the multiplicity of regions and motifs. Hallucinations induced by absinthe, the popular liqueur of the period, may explain particular canvases but not the majority of 'high yellow' paintings. Van Gogh's proclivity for exaggerated colours and his embrance of yellow in particular are clear from his letters and, in contradistinction to chemical or physical insults modifying perception, artistic preference is the best working hypothesis to explain the yellow dominance in his palette.

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Ocular Manifestations of Digitalis Toxicity

Cited by 39 publications

References 24 publications

Clinically Important Ocular Reactions to Systemic Drug Therapy

Clinically Important Ocular Reactions to Systemic Drug Therapy

The Role of Multifocal Electroretinography in the Assessment of Drug-Induced Retinopathy: A Review of the Literature

Xanthopsia and van Gogh's yellow palette

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