Riba recommends that ophthalmologists take a detailed history of recent and previous medication use. Sometimes the ocular effects of these medications can remain for a few weeks after a patient discontinues use of the medication. 4 Managing patients who use these medications However, the results are mixed a large study published in Ophthalmology did not find a connection between SSRIs and cataract formation. There are also reports in the literature regarding cataract formation and the use of antidepressants and anxiolytics. Glaucoma can be a less common but serious effect of some anti-anxiety agents and antidepressants. “Topiramate, an anticonvulsant that is often used off-label, can have major ocular side effects such as changes in vision related to movement of the lens, angle closure glaucoma, difficulty with accommodation, and difficulty with eye movements.” “Lithium for bipolar disorder is known to cause dry eye and difficulty with coordination of eye movements,” Dr. 2,3Ī change in coordinated eye movement is yet another effect of some agents. 1 There are also studies that have found a greater link between depression and dry eye, even beyond the effect of specific medications. “Within the broad category of anxiolytics, hydroxyzine hydrochloride and diphenhydramine, both antihistamines, can cause dry eye, blurry vision, and dilated pupils,” he said.Ī report in the Tear Film & Ocular Surface Society Dry Eye Workshop II addressed the link between dry eye and several systemic drugs, including anxiolytics/benzodiazepines and antidepressants/antipsychotics. Some antidepressants have a greater association with dry eye, including citalopram, fluoxetine, fluvoxamine, alprazolam, and sertraline, Dr. “In patients with these psychiatric conditions, I am more concerned about compliance if they stop their medications without the approval of their prescribing physician.” Ethan Tittler, MD “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 overstimulates their reflex tear production, resulting in tears dripping down the cheeks, Dr. The symptoms of dry eyes frequently coincide with dry mouth,” said Ethan Tittler, MD, Central Valley Eye Medical Group, Stockton, California. “Antidepressant medications are associated with dry eyes. This blurry vision can be particularly bad and even debilitating if a patient has another eye condition, such as glaucoma or dry eye, said Michelle Riba, MD, professor, Department of Psychiatry, University of Michigan, and associate director, University of Michigan Comprehensive Depression Center, Ann Arbor.ĭry eye is yet another effect of some agents in these drug groups. “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 younger patients who may need to use reading glasses, even if they are not of traditional reading glasses age, Dr. “The most commonly prescribed anti-anxiety medications are the SSRIs ,” said Ming Wang, MD, Wang Vision Institute, Nashville, Tennessee. One common effect of some of these agents is blurred vision. Plus, living with a chronic eye condition like glaucoma or wet age-related macular degeneration (AMD) has been associated with depression-hence why another group of patients seen by ophthalmologists may turn to antidepressants.īut are ophthalmologists looking out for the ocular effects caused by antidepressants or anti-anxiety medications? Ocular effects With that large percentage, ophthalmologists probably encounter patients daily who use or have used these medications. EyeWorld Contributing Writer Most effects easily managed but still require vigilance from ophthalmologistsĪbout 1 in 5 Americans use antidepressants or anti-anxiety medications.
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