This article is more than 5 years old. Information may no longer be current.
COX-2 inhibitors associated with visual impairment
Click Here to Manage Email Alerts
Use of a popular class of anti-inflammatory drugs can be associated with severe, although temporary, visual disturbances, usually within the first week of drug therapy initiation, according to a recent publication. Adverse reaction to the selective cyclo-oxygenase-2 inhibitors, or COX-2 inhibitors, may be under-reported and under-recognized, the authors of the report said.
David Morris Coulter and colleagues in the Intensive Medicines Monitoring Programme in New Zealand reported two cases of acute severe temporary visual disturbances in patients taking the COX-2 inhibitors celecoxib and rofecoxib. Monitoring of those drugs began in New Zealand in December 2000.
In one case, an 81-year-old man was prescribed 100 mg of celecoxib for analgesia. Three weeks after beginning the COX-2 inhibitor treatment, he reported central loss of vision. Once celecoxib was discontinued, the disturbance was rectified. Seven months after discontinuing treatment, vision loss had not recurred.
In the second case, a 78-year-old man was treated for shoulder pain with rofecoxib. Over a 24-hour period, he took 100 mg of the drug and awoke with blurred vision. His visual acuity was rated “nil useful vision” in one eye and 6/18 in the other eye, according to his general practitioner. An ophthalmologist found he had minor cataract and retinal degeneration consistent with age; visual acuity was normal. Five months after discontinuing rofecoxib use, the patient had no recurrences of visual loss.
The authors also reported cases seen by other physicians. Three cases were reported as “blurred vision” and one as “vision reduced.” Once the drug was discontinued, all patients recovered rapidly, according to the report.
“Inhibition of either COX-1 or COX-2 may alter the cyclo-oxygenase pathway and in turn alter regulation of retinal blood flow with potential changes in vision,” the authors reported in the November issue of the British Medical Journal. “The characteristics of the cases are consistent with this mechanism.”
While there are “relatively large numbers of reports” of visual disturbances reported to the World Health Organization after COX-2 inhibitor use, the study authors said, they found only one published account in the medical literature.