Eyeworld

21 EW NEWS & OPINION February 2018 by Vanessa Caceres EyeWorld Contributing Writer dry eye and several systemic drugs, including anxiolytics/benzodiaze- pines and antidepressants/antipsy- chotics. 1 There are also studies that have found a greater link between depression and dry eye, even beyond the effect of specific medications. 2,3 A change in coordinated eye movement is yet another effect of some agents. "Lithium for bipolar disorder is known to cause dry eye and difficulty with coordination of eye movements," Dr. Wang said. "Topiramate, an anticonvulsant that is often used off-label, can have ma- jor ocular side effects such as chang- es in vision related to movement of the lens, angle closure glaucoma, difficulty with accommodation, and difficulty with eye movements." Glaucoma can be a less common but serious effect of some anti-anxi- ety agents and antidepressants. There are also reports in the literature regarding cataract forma- tion and the use of antidepressants and anxiolytics. However, the results are mixed; a large study published in Ophthalmology did not find a con- nection between SSRIs and cataract formation. 4 Managing patients who use these medications Sometimes the ocular effects of these medications can remain for a few weeks after a patient discontin- ues use of the medication. For this reason, Dr. Riba recommends that ophthalmologists take a detailed history of recent and previous med- ication use. It's possible that previ- ous medication use may cause eye symptoms that someone is currently experiencing. Ophthalmologists always ask about current medication use, and this can help guide treatment for patients experiencing vision chang- es, Dr. Riba said. For instance, if a patient is newly using an antidepres- sant or anti-anxiety agent or has had a dose change, wait before fulfilling their request for a new glasses or contact prescription if possible. They may have vision changes from the medication that will subside or stabilize within a short time, Dr. Riba said. "Antidepressant medications are associated with dry eyes. The symptoms of dry eyes frequently co- incide with dry mouth," said Ethan Tittler, MD, Central Valley Eye Medical Group, Stockton, California. "The ocular dryness that can result from these medications can cause a burning, gritty sensation in the eyes, along with blurry vision." Some patients also experience excessive tearing as the irritation overstim- ulates their reflex tear production, resulting in tears dripping down the cheeks, Dr. Tittler said. Some antidepressants have a greater association with dry eye, including citalopram, fluoxetine, fluvoxamine, alprazolam, and sertraline, Dr. Tittler said. "Within the broad category of anxiolytics, hydroxyzine hydrochloride and diphenhydramine, both antihis- tamines, can cause dry eye, blurry vision, and dilated pupils," he said. A report in the Tear Film & Oc- ular Surface Society Dry Eye Work- shop II addressed the link between Ocular effects One common effect of some of these agents is blurred vision. "The most commonly prescribed anti-anxiety medications are the SSRIs [selective serotonin reuptake inhibitors]," said Ming Wang, MD, Wang Vision In- stitute, Nashville, Tennessee. "They are known to cause near focusing difficulty such as blurred vision when reading related to changes in pupil and ciliary muscle function." This happens most often in young- er patients who may need to use reading glasses, even if they are not of traditional reading glasses age, Dr. Wang said. This blurry vision can be partic- ularly bad and even debilitating if a patient has another eye condition, such as glaucoma or dry eye, said Michelle Riba, MD, professor, De- partment of Psychiatry, University of Michigan, and associate director, University of Michigan Comprehen- sive Depression Center, Ann Arbor. Dry eye is yet another effect of some agents in these drug groups. Most effects easily managed but still require vigilance from ophthalmologists A bout 1 in 5 Americans use antidepressants or anti-anxiety medica- tions. With that large percentage, ophthalmol- ogists probably encounter patients daily who use or have used these medications. Plus, living with a chronic eye condition like glaucoma or wet age-related macular degeneration (AMD) has been associated with de- pression—hence why another group of patients seen by ophthalmologists may turn to antidepressants. But are ophthalmologists look- ing out for the ocular effects caused by antidepressants or anti-anxiety medications? Monitor the eyes for ocular effects from antidepressants, anti-anxiety medications continued on page 22

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