Watch for Complications of Systemic Meds

Hot Topic

SYSTEMIC MEDS LINKED WITH OCULAR COMPLICATIONS

A new study published in Eye investigated links between certain systemic medications and three common eye conditions: blepharitis, meibomian gland dysfunction (MGD), and chalazia. The researchers analyzed data from the FDA Adverse Event Reporting System from late 2003 to mid-2024, reviewing 1,923 blepharitis cases, 202 MGD cases, and 290 chalazia cases. Patients were typically in their early 50s, with more women affected (58.3% for blepharitis, 60.9% for MGD, and 64.5% for chalazia). Approximately 70% of the reports came from North America, and health care professionals submitted roughly 55% of them.

The study found that specific medications were strongly associated with these eye conditions. Finasteride was linked to MGD, bortezomib to chalazia, and dupilumab to all three conditions. Other drugs, such as isotretinoin, docetaxel, and infliximab, were mainly tied to blepharitis. These medications can disrupt the delicate balance of the ocular surface by affecting oil glands, immune responses, or blood vessel function, leading to inflammation around the eyelids. The researchers noted that doctors might not always consider these drugs as causes of eye issues.

However, stopping these medications may not be practical, given that they are vital for treating severe health conditions. Instead, the researchers suggested doctors stay alert for ocular side effects, especially in at-risk patients, and recommended preventive steps such as teaching patients about proper eyelid hygiene and urging them to report symptoms early. While these medications are essential for overall health, the study highlights the need for awareness of their potential to cause eye problems. It encourages proactive management to minimize risks without altering necessary treatments.

My Two Cents

This study really resonates with me. As a teenager, I had a mild case of acne, and I distinctly remember my parents asking if I wanted to take a pill that would likely improve it dramatically, as it had multiple kids in my class with similar issues. As a self-conscious teenager, my answer was “absolutely yes,” and I didn’t care about the long-term side effects. That medication, if you haven’t guessed it already, was isotretinoin. Sure enough, it dried my skin out to perfection and made this oily teenage boy significantly less oily. However, it did likely cause long-term damage because my meibomian glands are absolute trash.

Although I can’t prove that my glands were damaged from the systemic medication, that is my longstanding assumption. Ever since, dry eyes have been a part of my daily story (and why I’m so passionate about that area of our profession!). As a doctor, I would recommend you commit these medications to memory as ones that you need to be aware of that have a significant effect on your patients’ ocular surface health.

OUTSIDE THE LANE

NICOTINE INCREASES RISK OF DIABETES

A recent study presented at the European Association for the Study of Diabetes annual meeting reinforces smoking as a significant risk factor for type 2 diabetes across all four subtypes: severe insulin-deficient diabetes (SIDD), severe insulin-resistant diabetes (SIRD), mild age-related diabetes (MARD), and mild obesity-related diabetes (MOD). Analyzing data from more than 3,300 individuals with type 2 diabetes and nearly 3,900 controls from prior studies in Norway and Sweden, researchers examined smoking status and its effect on diabetes risk.

The findings, yet to be peer-reviewed, revealed that both current and former smokers faced a higher risk of developing type 2 diabetes compared with nonsmokers, with the risk doubling for SIRD. Specifically, those who had smoked at any time had a 20% increased risk for SIDD, 27% for MARD, and 29% for MOD. Heavy smokers (20 cigarettes daily for 15 years) showed even greater risks, with a 2.35-fold increase for SIRD, 45% for MARD, 52% for SIDD, and 57% for MOD. The study also explored smokeless tobacco products and found a 19% higher risk for SIDD and 13% for SIRD, suggesting nicotine’s role in increasing insulin resistance.

These findings highlight that nicotine-containing products, including e-cigarettes and nicotine pouches, may elevate diabetes risk despite being marketed as less harmful. The study underscores the need for tailored prevention strategies, as smoking affects all diabetes subtypes—particularly SIRD—due to its effect on insulin resistance. Researchers aim to investigate further how modifiable risk factors such as tobacco interact with genetics to shape diabetes development. Experts emphasize that these results debunk myths that smoking reduces diabetes risk by controlling weight, urging greater awareness of lifestyle factors such as diet and exercise to mitigate risk.

My Two Cents

Well. Well. Well. Yet more data supporting why we should all avoid vaping and help our patients quit. The number of young patients (and some of my own staff) who vape because “it’s healthier and better” than smoking is astounding. This new study can arm us with yet another piece of crucial information that we can use to educate those who are smoking or vaping about some of the other unintended health problems it can cause. Personally, I had never considered that vaping or nicotine patches could increase the risk for type 2 diabetes; however, it makes perfect sense, as it influences insulin resistance!

CAN YOU RELATE

As I sit on a plane to Vision Expo West, I am contemplating what I’m most excited about at the conference. Obviously, I always love catching up with all my conference friends—everyone who knows all the trials and tribulations that you go through as an eye doctor. They don’t see you as “competition” because they’re located nowhere near you, so you can bounce ideas off them and be honest about your current challenges. That’s always my #1 at meetings.

We are always asking each other, “What’s new in your practice, what are y’all starting to explore?” Obviously, my big thing is dry eye, and I’m sure much of my conversations will be about how crowded the market is, particularly with the addition of Tryptyr (Alcon), which, by the way, I’ve had tremendous success with! I’m currently treating myself with intense pulsed light, Tryptyr, Miebo (Bausch + Lomb), HyloForte drops (Optase), the Dry Eye Drink (Bruder) in the evenings, and a disposable eye hydration mask a few nights per week with great success!

The significant push in our practice is the Williamson Eye Initiative for more Interventional Glaucoma treatments for our patients. We have decided that our patients are better served with minimally invasive procedures, which often reduce or eliminate their need for glaucoma medications. By getting many of our patients off drops (especially that darn generic latanoprost), we can improve our patients’ compliance and help their ocular surface, all while (likely) giving them better medical care. We have had tremendous success with incorporating selective laser trabeculoplasty into our care, as well as the Durysta (Abbvie), iDose (Glaukos), and iStent infinite (Glaukos).

The results have been incredible, compliance is good, and patient reception is outstanding. Why did it take us this long??

My challenge to you is to thoroughly examine your glaucoma patients and determine if they could benefit from an interventional glaucoma procedure (pro tip: They almost all can). Ask patients if they’re interested in a procedure that could help treat their glaucoma to the point where they may be able to stop using drops. Even if you live in a state where you can’t do selective laser trabeculoplasty or other advanced procedures, find yourself a collaborative MD and create a game plan. It really is what’s best for the patients, and it should become standard of care in the immediate future.

QUOTE OF THE WEEK

“Why do you go away? So that you can come back. So that you can see the place you came from with new eyes and extra colors. And the people there see you differently, too. Unless you forgot your wallet at home.”

— Terry Pratchett