Ocular toxicity from systemically administered xenobiotics

Abstract

Introduction The eye is considered as the most privileged organ because of the blood–ocular barrier that acts as a barrier to systemically administered xenobiotics. However, there has been a significant increase in the number of reports on systemic drug-induced ocular complications. If such complications are left untreated, then it may cause permanent damage to vision. Hence, knowledge of most recent updates on ever-increasing reports of such toxicities has become imperative to develop better therapy while minimizing toxicities. Areas covered The article is mainly divided into anterior and posterior segment manifestations caused by systemically administered drugs. The anterior segment is further elaborated on corneal complications where as the posterior segment is focused on optic nerve, retinal and vitreous complications. Furthermore, this article includes recent updates on acute and chronic ocular predicaments, in addition to discussing various associated symptoms caused by drugs. Expert opinion Direct correlation of ocular toxicities due to systemic drug therapy is evident from current literature. Therefore, it is necessary to have detailed documentation of these complications to improve understanding and predict toxicities. We made an attempt to ensure that the reader is aware of the characteristic ocular complications, the potential for irreversible drug toxicity and indications for cessation.

Drug-induced corneal epithelial changes

“…Corneal changes due to clofazimine are typically described as a fine granular line or lines in the inferior cornea that can be brown 80 to reddish brown and can occur in a little over half of all treated patients, frequently in conjunction with conjunctival pigmentation. 25 These changes do not result in decreased visual acuity. Bull's eye maculopathy is rarely reported.…”

“…The phenothiazine antipsychotic chlorpromazine has been known to induce vortex-like corneal epithelial deposits 67 when administered at high doses or lower long-term doses, 3 but more typically, these deposits appear in the stroma 25,27 or endothelium. 41,43,84 Of 43 patients who had taken chlorpromazine, 4.7% had corneal epithelial manifestations described as diffuse opacification "exposed in the palpebral aperture," sometimes with a "brownish-white opacification radiating from the optic axis."…”

“…3 The ocular complications were reported at first only in women 27 but are now observed to be more evenly distributed between men and women. 41 Associated ocular toxicities include anterior subcapsular cataracts, 25,41,43 corneal edema, 25 and pigmentary retinopathy. 27 Corneal and some lenticular changes can be slowly reversible after drug cessation, but the lenticular changes are less likely to resolve.…”

Monocarboxylate transporter mediated uptake of moxifloxacin on human retinal pigmented epithelium cells

“…Localized drug delivery is an important alternative to systemic therapy owing to its fewer side effects upon chronic drug exposure. Intravitreal injection is the most common localized drug delivery route for treating retinal ailments such as age‐related macular degeneration, diabetic retinopathy, retinoblastoma and endophthalmitis …”

“…Intravitreal injection is the most common localized drug delivery route for treating retinal ailments such as age-related macular degeneration, diabetic retinopathy, retinoblastoma and endophthalmitis. [1,2] Postoperative endophthalmitis remains as a most devastating complication of cataract surgery possessing significant vision threat. Moxifloxacin (Figure 1), a fourthgeneration fluoroquinolone, has shown a potent and rapid bactericidal activity against postoperative endophthalmitis pathogens.…”