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Study explores potential link between fluoroquinolone use and diplopia
Ophthalmology. 2009;116(9):1814-1817.
Use of fluoroquinolones was found to cause diplopia in some patients but appeared to be reversible upon cessation of the drug, according to a study.
Physicians should be keenly aware of the possible association, the study authors said.
"Clinicians are encouraged to be aware of fluoroquinolone-associated diplopia and should consider stopping therapy after consultation with the prescribing physician if diplopia occurs," they said. "Future studies could focus on active surveillance and more rigorous clinical evaluation when a patient presents with possible fluoroquinolone-associated diplopia."
Fluoroquinolones have been associated with tendon ruptures and may also affect extraocular muscle tendons, the authors said.
Investigators studied spontaneous reports from the National Registry of Drug-Induced Ocular Side Effects, World Health Organization and U.S. Food and Drug Administration on fluoroquinolones causing diplopia between 1986 and 2009.
Reports included type of fluoroquinolone, age, gender, adverse drug reactions, dosage, therapy duration, concomitant drugs, systemic disease, and dechallenge and rechallenge data.
Collected data showed 171 reported cases of diplopia associated with fluoroquinolones. Median patient age was 51.6 years. The patients included 76 men and 91 women; gender was not indicated in four cases.
Seventy-five reports were associated with ciprofloxacin, 40 with ofloxacin, 20 with levofloxacin, 16 with moxifloxacin, 11 with norfloxacin and nine with gatifloxacin.
The median time to onset of diplopia from the beginning of fluoroquinolone therapy was 9.6 days (range, 1 day to 5 months); time to onset was specified in 86 reports. Diplopia reportedly resolved in 53 cases in which fluoroquinolone use was discontinued, the authors said.
Physicians may report suspected fluoroquinolone-associated adverse events to the National Registry of Drug-Induced Ocular Side Effects at www.eyedrugregistry.com.
This study brings up the interesting issue of tendon inflammation and the possible link with extraocular muscle tendon reaction with systemic fluoroquinolone usage. The most striking reports are of a severe Achilles tendonitis with occasional Achilles tendon rupture. The skeletal muscular tendonitis has been more common in renal transplant patients and patients on oral corticosteroids. This report emphasizes the importance of reporting such ocular side effects of systemic therapy to the National Drug Registry of Ocular Induced Side Effects (http://www.eyedrugregistry.com), which acts as a surveillance center for these types of unusual systemic reactions that can also affect the visual system.
– Scott M. MacRae, MD
OSN Optics Board
Member