Medications/Drugs that can Cause Optic Nerve Damage

Medications/Drugs that can Cause Optic Nerve Damage
There are many medications that can cause damage to the eye. Depending on the presence of other risk factors (ie, family history of vision loss, blindness, glaucoma) these medicine below can increase one’s risk for optic nerve damage that can 

Most Oral Contraceptives
Increases risk of vascular occlusion which can cause permanent, irreversible nerve damage in some patients.
All Steroids
Inhaled, by mouth, by injection, topical, drops.
VIAGRA: CAN Cause Sudden, Permanent loss of vision in patients
with small cup to disk ration (“Disk at Risk”)

Birth Control Pills May Raise Eye Risks


CreditStuart Bradford
Women who use oral contraceptives for several years or longer may want to consider having their eyes checked more regularly as they get older. New research suggests that the pills may double their lifetime risk of developing glaucoma, a degenerative eye disease that can cause blindness if left untreated.
The researchers cautioned that their findings should not discourage women from using oral contraceptives, since the risk of glaucoma for the average adult over the age of 40 remains fairly low. But they said that doctors should be aware of the link, and that women who are using birth control pills — an estimated 11 million or more American women — should keep tabs on their long-term eye health.
Why birth control pills might play a role in glaucoma is not entirely clear. But cells in the optic nerve contain estrogen receptors that are believed to play a role in protecting the eyes from age-related decline, and the pills may interfere in that process by depressing estrogen levels. Researchers have previously found that women who enter menopause early or take medications that block estrogen, like drugs used against breast cancer, also have an elevated risk of glaucoma.
A sometimes painful eye disease, glaucoma affects between two and three million Americans. The most prevalent form of the condition, called open angle glaucoma, is caused by the gradual clogging of drainage canals in the eyes, creating a build-up of pressure inside the eye. The disease is more common in African Americans and in people who have a family history of the illness.
The new study looked at data on 3,406 women over the age of 40 who were followed for many years as part of the ongoing National Health and Nutrition Examination Survey, which is carried out by the Centers for Disease Control and Prevention. The women regularly underwent eye exams and answered questions about their reproductive health and medical histories.
Women who reported having used birth control pills of any kind for three years or longer had a 5 percent risk of developing glaucoma, compared with a risk of about 2.5 percent in the general population, said Dr. Shan Lin, a professor of clinical ophthalmology and the director of the glaucoma service at the University of California, San Francisco medical school. Dr. Lin presented his findings this week at a meeting of the American Academy of Ophthalmology in New Orleans.
Dr. Lin cautioned that the findings were preliminary and showed only a correlation, not causation. But together with data from previous studies they suggest that there is a relationship between estrogen levels and the development of eye disease.
Two years ago, a large study published in the journal Eye looked at data on nearly 80,000 women who were followed for three decades as part of the Nurses’ Health Study. Women who reported using birth control pills at any point in their lives did not have an elevated risk of glaucoma. But those who specifically had used them for five years or longer did experience a modestly elevated risk of the disease.
A growing body of evidence suggests that women who go into menopause early or have their ovaries removed are also at slightly greater risk of glaucoma, while those who experience menopause later and take postmenopausal hormones appear to be at lower risk, said Dr. Louis Pasquale, the author of that study and an associate professor of ophthalmology at Harvard Medical School. He said that estrogen appears to have a “maintenance effect” on retinal ganglion cells in the eye, which are known to have estrogen receptors.
“We think the presence of estrogen helps keep those cells alive,” Dr. Pasquale said. “And so things that happen to women over the course of their lifetime that would reduce their estrogen would increase their risk because glaucoma is a degenerative condition.”
In men, the same cells of the eye appear to have estrogen receptors as well. But Dr. Pasquale said it is not yet known whether fluctuations in hormone levels would have a similar effect in men. “We’re just beginning to scratch the surface of that,” he said.
Dr. Pasquale said that researchers were working on developing topical agents for the eyes that could mimic the protective effect of estrogen. Those drugs, however, have only been tested in animal models, and they are perhaps 10 to 15 years away from human trials.
Ophthalmologists generally recommend annual eye screenings for people 65 and older. But African Americans and people who have diabetes or a family history of eye diseases are typically told to begin the screenings sooner, and women with a history of taking birth control for long periods may be advised to start earlier as well.
“I think, over all, that women need to be cognizant that there may be a connection between their reproductive health and their eyes,” said Dr. Pasquale. “While one wouldn’t necessarily make decisions about their reproductive health based on what might happen to their eyes, they should have their eyes examined if they’re someone that took a lot of oral contraceptives or if they have menopause early.”
2. Optic Nerve Head Drusen: if present and patient is on Oral Contraceptives, a vascular occlusion is more likely in some patients.
As optic nerve drusen enlarge, they can compress and compromise nerve fibers and the vascular supply, leading to multiple complications including visual field defects, vascular occlusion, and hemorrhage (Sowka 2001). Vascular compromise to the optic nerve head may result in Anterior Ischemic Optic Neuropathy (AION)]. In patients with drusen, typical risk factors for AION are not necessarily present, with many of the patients affected being in their mid-20s or younger with no signs of any cardiovascular disease (Davis 2003).
Drusen have also been implicated in multiple types of vascular occlusive complications. Central retinal artery occlusion (CRAO) has been reported when drusen are present in conjunction in patients with systemic hypertension, migraine headaches, oral contraceptive use, high altitude, or atrial septal defect (Auw-Haedrich 2002). Approximately 10% of the venous retino-choroidal collateral supply is connected to ONHD, with central retinal venous occlusion as the major source. These vessels are the result of increased venous pressure from compression of the veins by drusen. As the patient ages, the vessels become more prominent due to enlarging drusen (Auw-Haedrich 2002).
Optic nerve drusen can also result in juxtapapillary choroidal neovascularization with subsequent hemorrhage. Choroidal neovascularization in younger patients is associated with a much better prognosis than in adults. In younger patients, resolution will occur with mild to moderate visual symptoms. In seven reported cases, six of the patients regained 20/40 vision or better without treatment (Harris 1981).
Optic neve drusen are associated with several ocular and systemic diseases. In retinitis pigmentosa the incidence of disc drusen is reportedly between 0 and 10%, but the drusen are often not visible, scleral canals are normal, and no disc elevation is present. Drusen is also associated with rare disorders such as pseudoxanthoma elasticum (with a prevalence of about 1:160,000) and angioid streaks (with a prevalence of 1:80,000). Although these two conditions are fairly rare, 85% of people with pseudoxanthoma elasticum also have angioid streaks, making drusen a common connection between the two conditions (Davis 2003).


No definitive treatment currently exists for optic nerve drusen. Patients with documented optic nerve drusen should be followed with serial visual field exams, optic nerve fiber analysis, and repeat intraocular pressure checks. If visual field loss occurs in the presence of drusen, medication to lower intraocular pressure should be considered. It may be difficult to distinguish optic nerve drusen from progressing glaucoma as the cause based solely on visual field testing (Davis 2003, Auw-Haedrich 2002).
Most cases of subretinal neovascularization associated with optic disc drusen resolve without treatment and with only mild symptoms. Laser photocoagulation should only be considered in cases if central visual acuity is threatened. (Davis 2003, Auw-Haedrich 2002).

Diagnosis: Optic Nerve Drusen


  • 1% of general population affected
  • Higher risk in Caucasian population
  • Inheritance thought to be autosomal dominant with incomplete penetrance, but remains unproven
  • Can be associated with other conditions (pseudoxanthoma elasticum, retinitis pigmentosa, angioid streaks)


  • 75-85% bilateral
  • Yellowish depositions on and around optic nerve
  • Edges of optic disc or cup may be distorted
  • Loss of optic cup and disc borders (may resemble papilledema)
  • Up to 8.6% reported to have transient visual obscurations


  • Usually asymptomatic
  • Visual field defects may be present (or develop over time)
  • In rare cases, central visual acuity loss may occur in association with the development of juxtapapillary choroidal neovascularization


  • No definitive therapy available
  • If visual field loss is present with drusen, may lower intraocular pressure with topical medicationto prevent progression of field defect
  • Laser photocoagulation to choroidal neovascularization if central acuity is threatened

Differential Diagnoses for appearance of Optic Nerve Drusen


  • Optic nerve head drusen are usually an independent finding, but can be related to other conditions, such as pseudoxanthoma eleasticum (PXE), retinitis pigmentosa, and angioid streaks.
  • Glaucoma and other causes for visual field loss must be considered when field loss is suspected due to optic nerve drusen.
  • Consideration of the appearance for optic nerve drusen (i.e. “lumpy-bumpy” appearance, elevation of the nerve head, irregular or blurred margins of the disc) must include consideration of any condition which causes blurring and elevation of the optic nerve head. This is essentially a differential diagnosis for disc swelling.

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