When people take medications for certain conditions, like blood pressure
or allergies, they don’t often think about eye side effects. But some
medications can cause side effects that affect the eyes, from mild dryness to
severe inflammation. Your eyes are relatively small but have a rich blood
supply, and that combination makes them vulnerable to side effects from
medications.
These side effects vary — and may involve any part of the eye,
from the cornea in the front of your eye to the retina and optic nerve in the
back of your eye. Let’s take a look at some commonly prescribed medications
that can affect your eye health.
Medications that may cause double vision or eye problems
Medications that cause double vision and other eye conditions include:
1. Alendronate (Fosamax)
Alendronate (Fosamax) belongs to a class of
medications called “bisphosphonates.”
Alendronate can treat osteoporosis, and it can lead to inflammation in
the front, middle, and back part of the eye. Symptoms of inflammation in the
eye include:
2. Topiramate (Topamax)
Topiramate (Topamax) can treat many conditions,
including seizures, migraine headaches,
and mood disorders. Topiramate can cause acute glaucoma (an
eye condition that damages the optic nerve). People often experience eye pain,
headache, and blurred vision. There are also reports of mydriasis (dilated
pupil), acute myopia (sudden nearsightedness), and other rare eye complications.
3. Isotretinoin (Accutane)
Isotretinoin (Accutane, Absorica) is an oral pill
that treats acne. A common side effect of isotretinoin is dry eye. Isotretinoin can also cause:
· Inflammation of the conjunctiva and eyelid (blepharoconjunctivitis)
· Light sensitivity (photophobia)
· Swelling of the optic nerve (papilledema)
4. Amiodarone (Cordarone)
Amiodarone (Cordarone) is a medication that treats
irregular heart beats, like atrial fibrillation. The risk of developing an eye
condition goes up if you’re taking a higher dose of amiodarone. Eye
complications are very common, even at lower doses, so people who take
amiodarone should get regular eye exams.
Vortex keratopathy is
one of the most common complications of amiodarone use. More than 70% of people
experience this side effect. Vortex keratopathy causes a swirl-like pattern to
appear on the cornea (the clear, front part of the eye). Some people don’t
experience vision changes from it, while others notice halos around
lights.
A more serious side effect from amiodarone is optic nerve damage.
The optic nerve connects the eye and the brain so you can see. Damage to the
optic nerve can lead to permanent vision loss.
5. Tamsulosin (Flomax)
Tamsulosin (Flomax) helps people urinate when they
have an enlarged prostate (benign prostatic hypertrophy)
or prostate cancer. If
you’re taking tamsulosin and you need cataract surgery,
talk to your eye doctor. Tamsulosin puts you at risk of developing
intraoperative floppy iris syndrome (IFIS).
In one study, more than half of people taking
tamsulosin developed IFIS during cataract surgery. Only 2% of people who didn’t
take tamsulosin developed the condition. It’s not clear why, but even if you
stop taking tamsulosin before surgery, you’re still at high risk of developing
IFIS. So you and your eye doctor will need to decide if cataract surgery is
right for you.
6. Sildenafil (Viagra)
Sildenafil (Viagra) treats erectile dysfunction (ED). Some people experience
changes in color perception after starting sildenafil. You may notice that
things look like they’re tinted blue. This does go away if you stop taking the
medication.
Another rare, serious side effect is damage to the optic nerve.
This can cause permanent vision loss. The risk of developing optic nerve damage
goes up if you’re taking a higher dose of sildenafil.
Tadalafil (Cialis) and vardenafil (Levitra) can also cause these eye
symptoms.
7. Tamoxifen
Tamoxifen is an antiestrogen medication that can
treat ovarian and breast cancer.
It can lead to to several eye problems, including:
· Retinal deposits
· Cornea clouding
· Swelling of the macula (macular edema)
Since these symptoms can lead to permanent vision loss, people who take
tamoxifen should get regular eye exams.
8. Chlorpromazine (Thorazine)
Chlorpromazine (Thorazine) is an antipsychotic
medication that can treat hallucinations and paranoia. Chlorpromazine can
cause:
· Pigment changes of
the cornea, eyelids, and conjunctiva (white part of the eye)
· Dry eye
· Blurry vision
· Retinal damage (retinal degeneration)
· Changes in color perception
· Decreased peripheral vision
· Inflammation and damage of the optic nerve
10. Hydroxychloroquine (Plaquenil)
Hydroxychloroquine (Plaquenil) treats rheumatoid arthritis, lupus, and other autoimmune disorders. This medication can cause
cloudiness in the cornea, which affects your ability to see clearly.
Hydroxychloroquine is also toxic to the retina. Damage to the retina
causes permanent vision loss. The risk of developing retinal damage is higher
for people taking higher doses of hydroxychloroquine. People who have been
taking the medication for a long time are also at higher risk. So be sure to
get regular eye exams while taking the medication.
11. Prednisone
Prednisone and other steroids can treat many
medical conditions, including eye conditions like uveitis. But some people can develop elevated eye pressure while taking this
medication. This causes steroid-induced glaucoma, which can lead to permanent
vision loss over time. But, if caught early, steroid-induced glaucoma can be
reversed. So be sure to see an eye doctor right away if you develop blurred
vision or eye pain while taking steroids.
12. Diphenhydramine (Benadryl)
Diphenhydramine (Benadryl) is an over-the-counter
antihistamine that relieves seasonal allergy symptoms. Benadryl can cause dry
eye and trouble seeing up close (because it makes your pupils get
bigger).
A serious side effect some people develop is acute angle-closure glaucoma,
which is a medical emergency. Acute angle-closure glaucoma causes permanent
vision loss if it’s not treated right away. When taking diphenhydramine, seek
emergency medical care if you develop:
· Blurry vision
· Headache
· Severe eye pain
· Vomiting
· Halos in your vision
13. Cidofovir (Vistide)
Cidofovir (Vistide) treats cytomegaloviral (CMV) retinitis, a viral infection of
the retina. Even though it treats a serious eye condition, it can also cause a
different problem in the eye — uveitis. Uveitis causes eye pain, redness, and
vision changes. If you take cidofovir, be sure to get regular eye exams to make
sure you’re not developing uveitis.
14. Digoxin (Lanoxin)
Digoxin (Lanoxin), or Digitalis, helps treat many
heart conditions. But it can cause vision changes, including:
· Double vision
· Blurry vision
· Light sensitivity
· Changes in color perception (yellow tint to vision)
These vision changes usually go away when you stop taking the
medication.
15. Fingolimod (Gilenya)
Fingolimod (Gilenya) is a newer medication that
treats multiple sclerosis.
It can cause macular edema, or swelling in the back of the eye.
Symptoms of macular edema include:
· Blurred central vision
· Shadows in vision
· Blank spots in the vision
· Changes in color perception (colors may look washed out or
muted, making them harder to tell apart)
People taking fingolimod should get regular eye exams.
16. Rifampin (Rifadin)
Rifampin (Rifadin) is another medication that
treats tuberculosis and other infections. Its most well-known side effect
is turning urine orange.
But it’s not just urine that changes color. Rifampin makes all bodily fluids
look orange-red, including tears. While this won’t affect vision, it will stain
contact lenses. This makes everything look orange when you’re wearing the
stained lenses.
The color of your tears will go back to normal once you stop taking the
medication. But you might want to switch to daily, disposable lenses or glasses
while taking rifampin.
17. Doxycycline (Vibramycin)
Doxycycline (Vibramycin)
is an antibiotic that treats many types of infections and helps treat other
medical conditions, like acne. People who take doxycycline for a long time can develop idiopathic intracranial
hypertension (IIH), also known as pseudotumor cerebri. IIH
causes an increase in the pressure inside the brain, which leads to:
· Blurred vision
· Double vision
· Headaches
Tetracycline and minocycline are similar antibiotics that can also
cause IIH.
What should you do if you develop vision changes or double
vision while taking one of these medications?
If you’re taking any of these medications and you develop vision changes,
double vision, or other eye symptoms — call an eye doctor right away. Early
treatment can protect your vision. Your eye doctor will also help you safely
taper or stop your medication.
The bottom line
People don’t always connect their vision changes to their
medications. But medications are a common cause of vision changes. There are
far more than 17 medications that can lead to vision changes and double
vision.
If you ever develop a new change in your vision or double
vision, see an eye doctor right away. Make sure you tell your eye doctor about
all of the medications you’re taking, including over-the-counter
supplements.
References
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Egan, R., et al. (2000). Sildenafil (Viagra) associated
anterior ischemic optic neuropathy. JAMA
Ophthalmology.
Glaucoma Research Foundation. (2022). When people with glaucoma
should avoid allergy and decongestant medications.
Goldstein, D. A., et al. (2021). Drug induced uveitis. EyeWiki.
Hesami, O., et al. (2016). Evaluation of ocular side effects in the patients on topiramate
therapy for control of migrainous headache. Journal of Clinical and Diagnostic Research.
Holst, A. V., et al. (2011). A severe case of tetracycline-induced intracranial hypertension. Dermatology Reports.
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Nayfield, S. G., et al. (1996). Tamoxifen-associated eye disease. A review. Journal of Clinical Oncology.
Phulke, S., et al. (2017). Steroid-induced glaucoma: An avoidable irreversible blindness. Journal of Current Glaucoma Practice.
Renard, D., et al. (2015). Spectrum of digoxin-induced ocular toxicity: A case report and
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