Does your vision seem to fluctuate? Does it seem clearer some days?
Have you ever considered your medications may be impacting your visual clarity? Medications play an important role in the management of health conditions by providing both relief and improvement in well-being. However, some medications can have a substantial impact on your vision, both temporarily and permanently.
Whether the medication is prescribed to address a chronic condition or over the counter for temporary relief, certain drugs may induce visual side effects that affect the clarity, focus, or overall health of the eyes. Understanding the potential impact of your medications on your vision is vital for both healthcare providers and patients alike so they can make informed decisions.
Here are a few common categories of medications that can affect vision and their ocular effects.
Allergy medications
Most allergy medications, including antihistamines, are designed to alleviate symptoms such as sneezing, itching, and congestion by blocking the action of histamine, a chemical released during an allergic reaction. While they primarily target histamine receptors, they can also affect other receptors in the body, leading to potential side effects, including those that may impact vision.
Common side effects related to vision that some may experience with certain allergy medications include blurry vision and dry eyes. These symptoms are more common with first generation antihistamines which can cross the blood-brain barrier, affect the central nervous system, and result in blurry vision.
Cold medications
Cold medications have various side effects, and one is an impact on vision.
It’s important to note that each individual responds differently to a medication, and not everyone will experience these side effects. Cold medications are like allergy medications in the way they affect vision, causing both blurry vision and dry eye.
Decongestants work by constricting blood vessels to reduce nasal congestion, and this constriction may also affect blood vessels in the eye possibly resulting in blurry vision. Antihistamines, often included in cold medications, can reduce tear production, leading to dry eyes.
Dry eyes can cause discomfort, redness, and temporary changes in vision. Prolonged use, especially in contact lens wearers, may result in a condition called superficial punctate keratitis (SPK). SPK is a condition of the cornea that may cause redness, light sensitivity, blurred vision, eye irritation, and discomfort.
Steroids
Systemic steroids can affect the entire body as they are typically taken by mouth or by IV. The impact on vision is often associated with both short-term and long-term use of these medications.
Long-term use of systemic steroids, especially at higher doses, is associated with an increased risk of developing a cataract. A cataract is clouding the eye’s natural lens, leading to blurry or cloudy vision.
Posterior subcapsular cataracts are the most common type of cataract caused by steroid use. This type of cataract grows very quickly and has a substantial impact on vision in a short period of time.
Prolonged use of ocular steroids can elevate intraocular pressure (IOP), increasing the risk of developing glaucoma.
Glaucoma is a condition characterized by damage to the optic nerve and is associated with increased pressure within the eye. It can lead to peripheral vision loss and, if left untreated, permanent blindness. If you are using steroid eye drops, your doctor will want to monitor your IOP.
Systemic steroids can suppress the immune system, making one more susceptible to eye infections. Infections such as herpes simplex virus (HSV) keratitis may be reactivated or exacerbated by systemic steroids, leading to symptoms such as redness, pain, and vision changes.
Lastly, in rare cases, systemic steroids have been associated with retinal issues, including central serous retinopathy (CSR). CSR results in fluid accumulation under the retina, leading to distorted or blurred central vision. This condition will often resolve without treatment but requires frequent monitoring. An affected individual is likely to notice distortions in their central vision.
Antimalarials
Antimalarial medications like chloroquine and hydroxychloroquine, are commonly used to treat and prevent malaria. These medications are also prescribed for certain autoimmune diseases, including rheumatoid arthritis and lupus. While generally considered safe and effective, antimalarials can have side effects that affect vision. The most significant concern is the potential for retinal toxicity.
Toxicity occurs with long-term use and with a higher dose of the medication. Today, the medication is prescribed based on a patient’s weight with 250mg being the most common dosage. Retinal toxicity can lead to damage to the retina cells specifically the cells responsible for central vision in the macula. Early signs may include subtle changes in color vision or visual field defects. Patients on Plaquenil should be monitored by an eye doctor annually.
Antidepressants
Antidepressants, medications used treat depression and various mood disorders, can have side effects that affect vision.
Blurred vision is a common side effect associated with certain antidepressants, particularly tricyclic antidepressants (TCAs) and some selective serotonin reuptake inhibitors (SSRIs). This side effect is usually temporary and tends to improve as the body adjusts to the medication.
Antidepressants, including SSRIs and TCAs, can also reduce tear production, leading to dry eyes. Tricyclic antidepressants may cause pupil dilation, leading to sensitivity to light (photophobia) and difficulty adjusting to changes in lighting conditions.
Isotretinoin
Isotretinoin, commonly known by the brand name Accutane, is a powerful medication used to treat severe acne. While isotretinoin primarily targets the sebaceous (oil-producing) glands to reduce acne, it can have vision-related side effects, including extremely dry eyes. This medication causes a decrease in the production of tears.
Some individuals taking isotretinoin have reported experiencing decreased night vision or difficulty seeing in low-light conditions, which is related to changes in the structure and function of the cornea. It may be transient and resolve once the medication is discontinued.
Oral contraceptives
Oral contraceptives, commonly known as birth control pills, are hormonal medications that contain estrogen and/or progestin. They are known to have various effects on the body, and some women may experience changes in vision as a side effect.
Hormonal changes induced by oral contraceptives can sometimes lead to dry eyes. Some women on oral contraceptives may experience discomfort when wearing contact lenses due to changes in tear production or the composition of tears.
Some women may experience increased sensitivity to light (photophobia) while taking oral contraceptives. A more serious complication of oral contraceptives is optic nerve swelling. While rare, optic nerve swelling can cause intense headaches, blurred vision, and permanent vision loss if left untreated.
As with any medication, the benefits and risks should be carefully considered, and decisions about your treatment should be made in consultation with a healthcare professional. Any new vision changes warrant a comprehensive eye exam. Regular follow-up appointments are important to monitor your response to the medication and address any ocular side effects.
