Topical ocular anesthesia has been part of ophthalmology for more than a century. The most commonly used drugs today are proparacaine, tetracaine, benoxinate (oxybuprocaine) cocaine and lidocaine. Although generally well tolerated, all these can be toxic, particularly when abused. The most common toxicities are to the ocular surface, but abuse can cause deep corneal infiltrates, ulceration and even perforation. Fortunately, systemic side effects are rare. Cocaine is unique for its higher incidence of systemic side effects and high abuse potential, both of which impede its clinical use. When used appropriately, all these drugs are remarkably safe. They are generally not prescribed for home use, as prolonged abuse of these drugs can be expected to result in serious complications.
Drug-induced ocular side effects are described according to recent reports from the literature, the National Registry of Drug-Induced Ocular Side Effects, the World Health Organization (WHO) and the FDA. Adverse events are categorised as certain, probable/likely, possible, unlikely, conditional/unclassified and unassessable/unclassifiable where indicated. Ocular side effects of clinical importance are highlighted with guidelines for recognition, reporting and treatment of adverse drug reactions (ADRs). The current and future status of pharmacovigilance in ocular toxicology is addressed.
This retrospective case series describes the association between ocular hemorrhage and 3-hydroxy-3-methylglutaryl conenzyme A (HMG-CoA) reductase inhibitors (statins). The clinical characteristics of 95 case reports submitted to the World Health Organization (WHO), the Food and Drug Administration, and the National Registry of Drug-Induced Ocular Side Effects are summarized with classification of this ocular side effect according to WHO criteria. The average time to onset of ocular hemorrhage was 300 days with 11 positive dechallenge reports and 2 positive rechallenge cases. Some patients also received medications known to increase bleeding times. From the collected data, ocular hemorrhage is "possibly" due to statin therapy.
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