Ophthalmologic disturbances

Another consistent symptom in adults is progressive, concentric narrowing of the visual fields. In children, it may not be found initially, but develops during the course of the disorder. Finally, a telescopic field of vision remains (Refsum 1946) with central vision being only slightly impaired or not at all. 

In addition to cataracts, miosis and asymmetric pupils with abnormal reaction to light have been described. Nystagmus may be present, as mentioned earlier. Ptosis and/or ophthalmoplegia externa were described only in questionable cases of HAP (Olesen 1957, Heycock et al. 1958, Ravin and Schwartz 1962) and do not seem to be typical features of the disease. 

Cardiac involvement was present in most patients and is certainly related to the underlying disease. Although the signs and symptoms referable to the heart vary in different subjects, angina pectoris and congestive failure occur rarely, while tachycardias and arrhythmias are frequent. Enlargement of the heart and nonspecific systolic murmurs have been described. 

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Of 30 children with epilepsy (14 boys and 16 girls, aged 4-20 years) taking vigabatrin for infantile spasms and simple and complex partial epilepsy, who had never complained of ophthalmologic disturbances, 4 had visual field... 

Ophthalmologic effects Effects include blurred or diminished vision, scotomata, changes in color vision, corneal deposits, and retinal disturbances, including maculas. 

HeierJS +, Ophthalmology I 13(4), 642 (2006) Rosenfeld PJ +, Ophthalmology I 13(4), 632 Maculopathy Ocular pain Ocular pruritus Ocular xerosis Retinal vein occlusion (2006) HeierJS +, Ophthalmology I 13(4), 642 Subretinal fibrosis Vision blurred Visual disturbances Vitreous floaters... 

Side effects of these drugs include CNS effects (e.g., headache, nervousness, insomnia, and others), rashes, dermatitis, pigmentary changes of the skin and hair, gastrointestinal disturbance (e.g., nausea), and reversible ocular toxicities such as cycloplegia and corneal deposits. Potentially serions retinal toxicity is uncommon when the currently recommended doses are used and is least common with hydroxychloroquine. However, because of the possibility of permanent damage associated with the retinopathy, an ophthalmologic evaluation should be done at baseline and every 3 months when chloroquine is used and every 6 to 12 months when hydroxychloroquine is used. If retinal abnormalities are noted, antimalarial therapy should be discontinued or the dose reduced. ... 

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