Systemic Reactions to Ophthalmic Drug Preparations

Abstract

Adverse systemic reactions associated with the use of topical ophthalmic timolol, chloramphenicol, phenylephrine and cyclopentolate are surveyed, with special emphasis on precautions and contraindications for these ophthalmic drug preparations. Systemic reactions secondary to timolol, a beta-adrenergic antagonist indicate that it should be used with caution in patients with asthma or a history of asthma, chronic obstructive pulmonary disease or cardiovascular disease and in those patients receiving systemic administration of beta-blockers or verapamil. Because significant blood dyscrasias or aplastic anaemia have been reported following topical ophthalmic chloramphenicol, the only absolute indication in ocular conditions is an organism that is resistant to all other antibiotics. Both 2.5% and 10% phenylephrine have been associated with cardiovascular effects and should be used with caution in selected patients on monoamine oxidase inhibitors, tricyclic antidepressants or atropine or in those with hypertension, advanced arteriosclerotic changes, aneurysms, orthostatic hypotension, long-standing insulin-dependent diabetes and in children with low bodyweights. Central nervous system toxicity secondary to cyclopentolate is dose-related and can be avoided by use of minimal concentrations and avoidance of unnecessary repetition of administration. Occlusion of the nasolacrimal passage with finger pressure immediately after instillation of any eyedrop also decreases the amount of drug that is absorbed systemically.

Co‐prescribing of topical and systemic beta‐blockers in patients with glaucoma: a quality use of medicine issue in Australian practice

“…This confusion raises the double‐spectre of simultaneous prescription of two fixed‐combination products, both containing timolol and the risk of topical timolol in the fixed‐combination escaping detection in patients taking, or being considered for systemic beta‐blockers. Topical beta‐blockers can be used to treat glaucoma, but they should be used in carefully selected patients 30,31 . The need for doctors to take coexisting conditions into account, particularly for elderly patients, has been emphasized in a recent New South Wales Medicines Information Centre bulletin on co‐prescription of topical and systemic beta‐blockers 22 .…”

“…Topical beta-blockers can be used to treat glaucoma, but they should be used in carefully selected patients. 30,31 The need for doctors to take coexisting conditions into account, particularly for elderly patients, has been emphasized in a recent New South Wales Medicines Information Centre bulletin on co-prescription of topical and systemic beta-blockers. 22 This bulletin reinforces that doctors must be aware of all drugs being used by their patients and specifically ask patients about non-oral medications.…”

Effects of Timolol and Latanoprost on Respiratory and Cardiovascular Status in Elderly Patients With Glaucoma

“…Plasma levels of ocular drugs are lower when lacrimal occlusion is applied with punctal occlusion or with fi nger pressure immediately after installation of any eyedrop. 21,22 In conclusion, glaucoma treatment with latanoprost seems to be safer in elderly people in comparison with the timolol treatment. Even if they have no history of airways disease, some deterioration can occur in the respiratory and cardiovascular systems due to beta-blocker therapy.…”

Mydriatic insert and intracameral injections compared with mydriatic eyedrops in cataract surgery: Controlled studies

“…5,42,[49][50][51][52][53] Repeated instillations result in significant amounts of administered drugs, carrying an increased risk for systemic adverse effects such as headache, increased blood pressure and heart rate, stroke, or myocardial infarction. 28,[54][55][56][57][58][59][60][61] These adverse effects have been reported in high-risk patients with a history of cardiovascular disease and in susceptible individuals without such history, 39,55,56,[62][63][64] especially neonates and infants. 58,59,65 The effect of mydriatic eyedrops tends to wear off during cataract surgery 48 in conjunction with an intraoperative reflex miosis 66,67 caused by the release of prostaglandins 21 or operative factors (eg, light from the microscope).…”