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EW NEWS & OPINION 38 September 2016 California, Los Angeles. One rare side effect is permanent and irrevers- ible retinal damage with optic nerve atrophy when patients have taken extremely high doses. "It is thought that the nerve damage is due to hypoxia, which could be related to the drug-related impaired oxygen carrying capacity and/or broken red blood cell fragments in the vessels," Dr. Shainhouse said. To reduce this medication's side effects, physicians should obtain a baseline G6PD enzyme level, con- duct other routine labs throughout therapy, and continuously question about side effects, she recommend- ed. "Dosage should be kept at the lowest effective dose and then stopped," Dr. Shainhouse added. Ultraviolet A therapy The use of ultraviolet A radiation therapy with oral psoralen (PUVA) helps some dermatologists manage chronic inflammatory lymphopro- liferative skin diseases, according to a report earlier this year in Clinics in Dermatology. However, this has also been linked to conjunctival hyper- emia, corneal superficial epithelial defects, and, more seriously, irre- versible lens opacities. However, the report analyzed several studies of ocular side effects from PUVA and did not find reports of lens opacities, although conjunctival hyperemia and decreased lacrimation did occur in patients who declined to wear UVA-blocking sunglasses after treat- ment. "It is recommended that all patients undergoing PUVA wear UVA-blocking opaque goggles during irradiation … [and] UVA opaque wraparound sunglasses should be worn for 24 hours after drug inges- tion," the authors concluded. 1 EW Reference 1. Turno-Krecicka A, et al. Ocular changes induced by drugs commonly used in dermatol- ogy. Clin Dermatol. 2016;34:129–137. Editors' note: The physicians have no financial interests related to their comments. Contact information Fishkin: Joseph@FishkinMD.com Jachens: ajachens@eyecare2020.com Shainhouse: questions@rapdermbh.com by Vanessa Caceres EyeWorld Contributing Writer idea that the enzyme can permeate enough to break up the emboli. Although this injection can be done by the dermatologist or ophthalmol- ogist, it also needs to be done within 90 minutes. When this problem occurs, patients should have an MRI or MRA because of the connection between ophthalmic occlusions from emboli and brain occlusions, Dr. Jachens recommended. Antihistamines Although ocular side effects from antihistamines are uncommon, they can occur. "When given for skin allergies, antihistamines can cause worsening of narrow angles and induce angle- closure glaucoma," said Joseph Fishkin, MD, Fishkin Vision, Emer- son, New Jersey. This is more likely in people who have anatomically narrow anterior chamber angles, according to the Glaucoma Research Foundation. Dr. Fishkin recommended gonioscopy done in the ophthal- mologist's office to determine who is at greater risk for angle closure and performing a laser iridotomy to help prevent an angle closure attack. "Pa- tients who are taking any drug that can precipitate angle closure should be educated about the importance of alerting their doctor of any new ocular symptoms," he said. He finds that when these patients call and are concerned about drugs worsening their glaucoma, they usually have open-angle glaucoma, and he reas- sures them that there's no associated risk with antihistamine use. Dermatologists should also ask about a history of glaucoma before prescribing antihistamines. Usually, antihistamines are fine for those with glaucoma, but this is another one to keep in mind should an acute attack occur. Dapsone Oral dapsone is a sulfone medica- tion used to treat dermatitis her- petiformis, the skin presentation of Celiac disease and gluten-sensitive enteropathy, and other blistering skin conditions, said dermatologist Tsippora Shainhouse, MD, Rapa- port Dermatology of Beverly Hills, and clinical instructor, Keck School of Medicine, University of Southern Cosmetic fillers When injected into the glabellar region or nasolabial fold, cosmetic fillers can embolize and occlude the ophthalmic artery, central retinal artery, or branch retinal artery and lead to blindness, said Adrian Jachens, MD, EyeCare 20/20, East Hanover, New Jersey. Although the chances of this side effect are rare, ophthalmologists should still be aware of it. "Intervention is needed within 90 minutes after insult for the retina to survive," Dr. Jachens said. "In typ- ical central retinal artery occlusion, ocular massage as well as hyperbaric oxygen may be helpful, which can be applied to this scenario." Phy- sicians can also do a retrobulbar injection of hyaluronidase with the Part two of a closer look at dermatology drugs that can affect the eyes A s EyeWorld reported in last month's issue, ophthal- mologists and dermatolo- gists need to be aware of ocular side effects po- tentially posed by certain common dermatology medications. EyeWorld reported previously on the potential ocular dangers from the anti-ma- larial drugs hydroxychloroquine and chloroquine, glucocorticoids, retinoids, and onabotulinumtoxinA (Botox, Allergan, Dublin). Here's how cosmetic fillers, oral antihista- mines, dapsone, and ultraviolet A therapy with psoralen could pose ocular risks in certain patients. Dermatology drugs, ocular side effects

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