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Medications with Light Sensitivity as a Side Effect

Medications with Light Sensitivity as a Side Effect

Posted by Greg Bullock on 12th Feb 2018

We spend a lot of time talking about the various conditions that can cause photophobia and light sensitivity, but did you know that certain medications can also bring about this symptom? While it is often rare—and of course we always recommend consulting with your physician before starting or stopping any medication or treatment—it is important to know which drugs can lead to light sensitivity either in small doses or when taken in excess.

Ibuprofen, Naproxen

(Non-Steroidal Anti-Inflammatory Drugs)

According to the American Optometric Association, several over-the-counter pain relievers known as non-steroidal anti-inflammatory drugs (NSAIDs) have been shown to bring about painful light sensitivity as a side effect. Notably, ibuprofen (Advil) and naproxen (Aleve) can be among those medications that can lead to the symptom, with one study showing that it may affect approximately 1% of patients.1 Unfortunately, these are incredibly common drugs and are often utilized for acute migraine attacks as well—which also can be associated with photophobia.

Dilantin

(Anticonvulsant for epilepsy)

There are numerous sources that list photophobia as a known side effect of Dilantin (generic name Phenytoin), although there is some debate as to how common it occurs for patients. Some experts suggest that sensitivity to light only develops for a fraction of patients, while others believe it is a “certain” side effect.2,3 At minimum, there have been numerous other vision-related deficits reported with Dilantin, including abnormal eye movements (nystagmus), pink eye (conjunctivitis), and glare phenomenon. Dilantin is used primarily for epilepsy as an anti-seizure medication, and it can also be prescribed for pain as well.

Methotrexate

(Anti-Rheumatic, Chemotherapy)

There is clinical evidence that methotrexate—used to treat certain forms of cancer as well as rheumatoid arthritis–can increase light sensitivity among patients.4 In instances where ocular problems persist and/or are serious, doctors may decide to reduce the dosage or identify alternative therapies.

Tetracycline, Doxycycline

(Antibiotics)

Tetracyclines are a class of antibiotics that generally treat bacterial infections, which can make them prescribed for everything from acne and other skin conditions to urinary tract infections and sexually-transmitted diseases. There are several known eye-related side effects–in particular with doxycycline—with sensitivity to light affecting a small percentage of patients. And these symptoms often disappear after you stop taking the drug.4,5

Digoxin

(Antiarrhythmic and other heart issues)

Used to treat heart issues (including heart failure and irregular heartbeat), Digoxin has evidence of causing visual problems like photophobia for patients. Some experts deem it to be very rare, and it typically is observed in patients over the age of 65 years old as well as those in which excessive use (or drug ‘toxicity’) is likely.6

Amiodarone

(Antiarrhythmic and other heart issues)

Another drug that is designed to help patients with irregular heartbeat concerns, amiodarone can lead to countless ocular problems. There is some debate about whether light sensitivity is a direct side effect of the medication, but experts do agree that it can lead to corneal microdeposits which can trigger photophobia, visual halos and glare—perhaps in as many as 3% of those who take it.7,8

Atropine

Photophobia is prevalent for patients who have taken atropine, which has multiple clinical applications—including as a treatment for dry mouth, specific eye disorders (e.g. myopia) and also as a muscle relaxant. Not surprisingly, its ophthalmic use can lead to eye dilation and thus trigger bouts of light sensitivity in as many as 72% of patients.9 In addition, excessive use of atropine can also lead to significant sensitivity to bright light as well as blurred vision.10

Thioridazine, Trifluoperazine

(Antipsychotics)

Numerous opticians warn of ocular side effects associated with antipsychotic medications, notably thioridazine and trifluoperazine. Although it is more likely to occur when exceeding normal dosages, photophobia can develop for a few patients.11

Cimetidine, Ranitidine

(Anti Ulcer, Acid Reflux)

Although rare, anti-ulcer medications and drugs that treat acid reflux disease can sometimes cause photophobic responses for patients. Specifically, cimetidine (Tagamet) and ranitidine (Zantac) are common over-the-counter versions of these drugs, and they can also lead to hallucinations, conjunctivitis and blurriness.12

Fingolimod

(Multiple Sclerosis)

Fingolimod (commonly prescribed as Gilenya) is an immunosuppressive drug known to help treat flare-ups caused by multiple sclerosis. It also has been used for dry eye. In both cases, it has been reported to lead to complaints of light sensitivity, sometimes related to a possible infection or macular edema.13,14


Are there medications that treat photophobia and light sensitivity?

Unfortunately, there are no drugs currently on the market that are approved specifically for the treatment of photophobia. There is recent evidence that Botox injections may improve symptoms of light sensitivity, but it is unclear if that is only tied to people with chronic migraine.15 As a result, the best solutions are a combination of lifestyle adjustments as well as products that can diminish the effects of light exposure—that also do not result in darkness-related isolation. Click below to see some of the suggested therapies for photophobia.

References:

1Gaynes BI, Onyekwuluje A. Topical ophthalmic NSAIDs: a discussion with focus on nepafenac ophthalmic suspension. Clinical ophthalmology (Auckland, NZ). 2008;2(2):355-368.

2https://www.drugs.com/sfx/dilantin-side-effects.html

3Fraunfelder FT, Fraunfelder FW, Chambers W (2014). Drug-Induced Ocular Side Effects: Clinical Ocular Toxicology E-Book. Elsevier Health Sciences. Retrieved from books.google.com.

4Szostakiewicz-Grabek B, Juszkiewicz-Borowiec M, Krasowska D. The effect of drugs used in treatment of skin disorders on visual system. Pol Merkur Lekarski. 2016 Apr;40(238):269-72.

5Valentín S, Morales A, Sánchez JL, Rivera A. Safety and efficacy of doxycycline in the treatment of rosacea. Clinical, cosmetic and investigational dermatology : CCID. 2009;2:129-140.

6Renard D, Rubli E, Voide N, Borruat F-X, Rothuizen LE. Spectrum of digoxin-induced ocular toxicity: a case report and literature review. BMC Research Notes. 2015;8:368. doi:10.1186/s13104-015-1367-6.

7Ingram DV. Ocular effects in long-term amiodarone therapy. Am Heart J. 1983 Oct;106(4 Pt 2):902-5.

8Shukla R, Jowett NI, Thompson DR, Pohl JE. Side effects with amiodarone therapy. Postgraduate Medical Journal. 1994;70(825):492-498.

9Polling JR, Kok RG, Tideman JW, Meskat B, Klaver CC. Effectiveness study of atropine for progressive myopia in Europeans. Eye (Lond). 2016 Jul;30(7):998-1004. doi: 10.1038/eye.2016.78. Epub 2016 Apr 22.

10National Research Council (US) Panel on Anticholinesterase Chemicals; National Research Council (US) Panel on Anticholinergic Chemicals. Possible Long-Term Health Effects of Short-Term Exposure to Chemical Agents: Volume 1 Anticholinesterases and Anticholinergics. Washington (DC): National Academies Press (US); 1982. 3, ANTICHOLINERGICS.

11Muchnick B. Which Side Effects are Lurking in the Shadows? Review of Optometry. 2013. Retrieved from reviewofoptometry.com.

12Wren V. Ocular & Visual Side Effects of Systemic Drugs: Clinically Relevant Toxicology and Patient Management. Journal of Behavioral Optometry. 2000;11(6):152.

13What to Know about Gilenya Safety. Retrieved from: http://www.gilenya.com/c/multiple-sclerosis/safety.

14Xiao W, Sun L, Zhang N, Ye W. Adverse Effect Profile of Topical Ocular Administration of Fingolimod for Treatment of Dry Eye Disease. Basic Clin Pharmacol Toxicol. 2017 Apr;120(4):398-406. doi: 10.1111/bcpt.12717. Epub 2017 Jan 22.

15Diel RJ, et al. Botulinum Toxin A for the Treatment of Photophobia and Dry Eye. Ophthalmology. 2017;125(1):139-140.

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