Ocular side effects of antirheumatic medications: a qualitative review

Abstract

TopicThis paper reviews the ocular side effects of medications used in the treatment of rheumatological conditions.Clinical relevanceRheumatic diseases are inflammatory conditions that may affect the skin, blood vessels, joints, muscles and internal organs. Immunosuppressive agents are often used as treatment and while powerful, they carry side effects and toxicities that need careful monitoring. Ophthalmic complications have been reported with the use of antirheumatic medications; however, there is a lack of literature synthesising these reports. This paper addresses this gap and hopes to inform both rheumatologists and ophthalmologists as they work together on the management of patients with rheumatological conditions.MethodsPubMed literature search was conducted from November to September 2019 searching for ocular side effects with the use of 25 rheumatological drugs.ResultsA total of 111 papers were included in this review. Adverse side effects were divided into non-infectious and infectious causes. Traditional disease-modifying antirheumatic drugs (DMARDs) were associated with pruritus, irritation and dryness of the conjunctiva while biologic DMARDS showed reports of new-onset/recurrent uveitis and demyelinating conditions. Infectious side effects included episodes of cytomegalovirus retinitis, toxoplasmic chorioretinitis and endophthalmitis. Other serious side effects were encountered and included in this review.ConclusionThe goal of this paper is to inform healthcare providers about potential ocular side effects from rheumatological medications. Healthcare providers are encouraged to learn more about these ophthalmic complications and find relevance within their clinical practice.

Resolution of Macular Edema secondary to rituximab after intravitreal dexamethasone: A case report and a review of the literature

“…Retinal necrosis, conjunctivitis and ME have been reported as possible side effects in patients treated with Rituximab. 1 ME is a rare consequence of Rituximab infusions and very few cases are reported in the literature. [3][4][5] Details on previous cases described are summarized in Table 1.…”

“…Retinal necrosis, conjunctivitis and ME have been reported as possible side effects in patients treated with Rituximab. 1…”

“…Many ophthalmic complications have been reported with the use of traditional and biologic disease-modifying antirheumatic drugs (DMARDs). 1 Rituximab is a monoclonal antibody, with anti-CD-20 activity, used in several hematological cancers and autoimmune diseases. IgG4-related disease (IgG4-RD) is an immune-mediated fibroinflammatory disorder that results from massive expansion of polyclonal IgG4-switched B and/or plasma cells and can virtually affect all organs.…”

A case of ustekinumab-induced sclerouveitis

“… 4 Paradoxical ophthalmologic reactions, including uveitis, sarcoid uveitis, scleritis, optic neuritis, diplopia, and visual field defects/scotomas have been reported in TNF-α inhibitors. 5 Ustekinumab (Stelara, Janssen Biotech Inc.) employs a different mechanism of action than the older anti-TNF agents. 6 It is an anti-p40 IL-12/IL-23 human immunoglobulin monoclonal antibody that reduces levels of IL-12/IL-23, which in turn downregulates multiple pro-inflammatory cytokines, such as TNF-α, IFN-γ, and IL-2.…”