Systemic effects of eye drops

Neuropsychiatric Adverse Events from Topical Ophthalmic Timolol

“…A few patients clearly had some cardiac events that may secondarily have caused neurological outfall, as some have suggested. 15,41 Overall, the side effects disappeared after a few hours to a month, which is consistent with the otherwise general experience of beta-blockers. 15,42,43 Children of young age are susceptible, although reports are few.…”

Risk of Systemic Toxicity from Topical Ophthalmic Chloramphenicol

“…4,14 I would regard pregnancy and lactation as contra-indications, but the drug company's pamphlet gives discretion to the pharmacist. 15 There is considerable evidence that cases of blood dyscrasia do occur from topical ophthalmic chloramphenicol 16,17,18 and the complication is under-diagnosed, 19 under-reported 18 and underpublished. 18 It is also under-referenced: a general review 19 contains the only published reference I have found to a paper 20 wherein two "personal communications" concerning one case each are mentioned.…”

“…15 There is considerable evidence that cases of blood dyscrasia do occur from topical ophthalmic chloramphenicol 16,17,18 and the complication is under-diagnosed, 19 under-reported 18 and underpublished. 18 It is also under-referenced: a general review 19 contains the only published reference I have found to a paper 20 wherein two "personal communications" concerning one case each are mentioned. Within two years of a report in 1982 17 of a fatal case of aplastic anaemia, sales in the USA declined by 90% 18 and "the Physicians Desk Reference used in the United States emphasises in boxed warnings repeated…that ocular chloramphenicol not be used unless there is no alternative".…”

Ocular phenylephrine 2.5% continues to be dangerous

“…Traditionally topical phenylephrine 10% is used by ophthalmologists for pupillary dilatation and capillary decongestion 1. Systemic side effects after absorption of phenylephrine ranges from transient hypertension, angina, cardiac arrhythmias and syncope to fatal haemodynamic changes, subarachnoid haemorrhage, pulmonary oedema, myocardial infarction, left ventricular failure and death 2 , 3. It was therefore suggested that a concentration of 2.5% should be used because it is safer 3.…”