My left eye felt like it was moving and jerking, but not insync with the right eye.By now, I convinced myself I had MS or a brain tumor.On Day 4, the Gastroenterologist took me off the Cipro and gave me Colestid for the diarrhea.  By the 5th day, I thought I was going to die. Started having sunburn sensation on legs, arms and back. Got  a red, measle-like rash that burned and itched??? (Cold compresses seemed to help and made the redness subside some.) Since it was the week-end, I got the on-call doctor who said it was good I stopped the Cipro and prescribed Valtrex for the rash (thinking it was shingles). She said that the muscle and eye
problems could be due to dehydration (since I wasn't really eating or drinking much.)(sic)

I like you had an ADR from taking Levaquin for a sinus infection. I too had a lot of the same symptoms that you described. My left eye pupil was always more dilated then the right and it felt like my eyes were reacting in slow motion at times. Symptom after symptom would changed and shifted or moved around as time went on another one who thought she had MS here. scariest time of my life. I had visual problems as well with a whacky neuro test on my right eye. my MRI was normal. No MS. I believe my eyesight has recovered. the burning and rash are VERY typical of quinolones (sic)

The absolute WORST thing, though, is the 'jerky' eye. It makes it hard to read and do most anything else.(sic)

I have been having problems with my eyes ever since taking cipro for a urinary problem. I took cipro 500 mg twice a day for about 6 - 8 weeks, a total of 1000 mg per day. I have floaters and spots in my vision. I have not been on the medication for several months but the problems still persist. Has anyone else had similar issues? (sic)

After mabey a month since i stop the cipro i started to have a little spot in the corner of my right eye and after in my left one. Now i have it for about a month and a half but i have about 2 or 3 spots in each eye, some its like a circle and some is like a piece of hair. But now, i ting that my spots dissolve because at first its was little and dark and now its bigger but less dark. I see an ophtalmologist and he said that everything is ok..i only have floaters(sic)

My adverse reaction to Avelox started out with a pain like no other in the right side of my face, involving the eye. It felt as if someone had a pair of pliers pulling at the back of my eye and the pain spred under my eye (felt like it was in the bone structure) down to the right side of my neck. I would go to bed crying,(which made the pain worse! for days!) thinking that this pain would eventually make me go stark raving mad. At times I understood Dr. Kavorkian! (sic)

I was diagnosed with 'Posterior Vitreous Detachment' in my right eye. Does this sound familiar to anyone? (sic)

I had exactly the same thing happen after taking Cipro. The Cipro was in January (second round, first was in the previous December.) and the eye problem began the middle of Feb. Still have clouding and debris in that eye. (sic)

I find it interesting because my mother who took Cipro for about 3 months for osteomyelitis last year now has several new eye problems. One of which is the beginnings of macular degeneration. I'd have to check with her what all the other problems are but, I think she has something similar to what Winnie was talking about, the vitreous detachment.(sic)

I was diagnosed with cataracts the year following levaquin and now four years later with macular degeneration, and was wondering if anyone else has been.(sic)

I wish I could recall exactly how long it took for my eyes to get better-- actually it was predominantly one eye. You really need to have an opthamologist look it over rather than simply an optometrist/optician. I also had abnormal nerve movement in the eye as measured by an EEG. (You watch a TV screen and the electrodes record the nerve tracking of the visual image).
(sic)

It's so strange, but as I look back for many many years, I have ALWAYS said that while and after taking an antibiotic, I had trouble with my eyes. Now, of course after being floxed and ciproed to death 6 years ago, I am really having trouble with my eyes. I go to an opth. Monday, the 20th to see why I have "narrow angles"!!!Another thing to add to my laundry list!!! (sic)

Just a note about eye symptoms. The first week I took Levaquin, I woke up with one eye totally dry and pink. I thought I had an eye infection but, it did resolve itself. Now my eyes may look red and veiny but, usually if I've slept poorly and I do have environment allergies. BUT, it was one of my initial reactions to the Levaquin.(sic)

I also had a sudden vitreous detachment in one eye immediately after taking a 10 day course of Cipro. This was among the other reactions, (sic)

Sorry to hear about how messed up your eyes are. I just completed my visit to an opthamologist(SP) for my vision problem in my left eye. (sic)

I mentioned this happened after taking Levaquin and thought it was a possible reason for my eye sight problems.. He said there are many drugs that can mess with the eyes, and Levaquin sure can be one of them..(sic)

Basically I have 20/40 vision in my left eye now, and 20/20 in my right.. No damage was noticed when he looked at my eye.. he told me it isnt that bad vision wise and see him in a couple years for another checkup..Well I guess good news for me for once :)... Anyway I hope you will one day be able to take those triple bifocals off and heal from this mess muscle wise..
(sic)

My eye doctor was not familiar with the ADR's to FQ's, however he listened intently and examined my eyes very carefully. He also told me that whenever anyone has, for example, Lasik surgery, the antibiotics used are likely to be FQ's: Ocuflox and Cipro. Something to keep in mind if anyone is considering that. (sic)

He said that as far as my actual vision goes, it's doing ok. I don't need to change my prescription. However the double vision and blurred vision I've been having, he thinks is because my eyes are not behaving in as flexible and coordinated a manner as they should be. I had problems with tracking an object and with getting my eyes to focus together. (sic)

I took 3 Cipro on July 9th, and have mostly been on the mend. But I've noticed short-term memory and word-recall problems lately.Does anyone have any insights on whether this could be from the Cipro, at this point in time, or just part of normal aging or whatever (I am 48, and for the most part, sharp as a tack). Also yesterday I had a short period of time where my vision got blurry for no apparent reason. (I called the eye doctor on that one, and have an appointment for next week.(sic)

Last Friday, I noticed a flash of light on the side of my right eye. It has continued to flash and some floaters are ocurring now that disturb my vision. Made an appt. with a opthamologist this morning for 1:45 PM today. Just got back a short time ago. He diagnosed me with "posterior vitreous base detachment". He said my retina looked alright, but if I had an increase in floaters or saw a veil (a sign of a detached retina) to call him right away. He said it should improve on its own and be much better in two weeks. I pray that is what will happen.(sic)

Whether Levaquin caused this or not, I don't know. But, I mentioned my ADR to the doctor and asked if it could have contributed to it and he did not say no or yes. (sic)

I too had a problem with flashes of light in the corner of my eyes after taking Avelox. It cleared up after five weeks, but has left me with floaters. I know this is alarming, but even if your retina does detach, there is surgery now that will help you as long as you get to the Dr right away if you see the "showers". I am not trying to make light of this situation, as I well know how terrifying it can be,(sic)

Following my Levaquin adverse reaction approx. two years ago, I have had tinnitus and eye floaters. Has anyone out there suffer similar symptoms and have them abate after two years? Is this damage permanent? If anyone has experience with the aforementioned symptoms or their associated treatments, I would greatly appreciate your comments (sic)

About a year ago (time flies) I posted an article - written in awkward English from a foreign eye surgeon - who stated that during an operation they scrapped off white stuff and found it was pure Cipro inside the eye - they had it tested it was the pure chemical which had condensed in the eye. (sic)

BALTIMORE Because of its lower pH, ciprofloxacin seems to form drug depots at the site of a break in the cornea, such as in a surgical corneal flap or the bed of a corneal ulcer, said Richard A. Eiferman, MD, clinical professor of ophthalmology in Louisville, Ky.
"We originally thought that was very bad and would impair wound healing," he said. "When we looked at the data we found that it did not impair wound healing. We looked at all our corneal ulcers and found that they healed the same length of time whether they had a precipitate or they didn't have a precipitate." One patient's corneal ulcer allowed Dr. Eiferman to study the drug depot more thoroughly. The ulcer caused the corneal tissue to melt, prompting a transplant to prevent perforation. The eye had been pretreated with ciprofloxacin, which had formed a precipitate in the ulcer bed. "I took the plaque out and I put it on a plate of bacteria and had a nice zone of inhibition," Dr. Eiferman said. "When we took it out a day later and put it in another plate of bacteria, it was still active." A laboratory analysis at Alcon Surgical sampled the precipitate and determined that it was pure fluoroquinolone, he added. "It had been my belief that this happens in every single corneal ulcer, but only in a few patients does it precipitate out so much that you can see it," he said. Dr. Eiferman is now analyzing four corneal transplants for ciprofloxacin deposits and intends to present his results at the meeting of the American Academy of Ophthalmology in October. "In the two studies that were done, the two drugs appear to be equivalent," Dr. Eiferman said. "My gut feeling is that Ciloxan may be better if it is sticking around in the ulcer bed." (sic)

Are depots effective?Discrete deposits of quinolones might not take advantage of the quinolonesââ‚â„¢ mechanism of action, said Terrence P. Brien,MD, in practice at the Wilmer Eye Institute in Baltimore and member of the Cornea/External Disease section of the Ocular Surgery News Editorial Board. "In general, it makes sense that a solution is better because if the drug is in solution it can penetrate to get to the site where the infection is going on," he said. "If you're talking about a corneal infection, it is in the stroma where the bacteria are replicating. If you have drug out on the surface, drug that's precipitated away from the active site, potentially it is not effective." Any study of the precipitate needs to examine whether the precipitated drug
is dissolving again into the tissue where it can have its antibiotic effect, he said. "Until that's proven we have to be careful saying that precipitates are a good thing." (sic)

Corneal precipitates found to be ciprofloxacin deposits
This seems to indicate that Flouroquinolones pool in areas of our bodies. The eye is the only place where this can be seen in clumps of pure chemical. It might explain why people report that they get better and then they get worse, the pure chemical might be breaking up over time and aggravating the intial ADR. (sic)

I remember reading that Levaquin keeps killing bacteria long after it is supposedly excreated through the kidney. This, residue in the eye, seems to show that the drugs never fully left, they may have just penetrated different tissues and stayed there. I just woke up about 20 minutes ago and I paid close attention to my sight. I am unable to see just about everything when I first wake up, everything is so blurry/cloudy, it seems to rake some time for my eyes to focus enough to even look at pictures taped to the wall in front of my desk with the PC on it. Then I have no choice but to put on my reading glasses for at least an hour to focus on the words on the PC.
(sic)

This just doesn't seem normal. And I still don't buy that an individual goes from wearing glasses for hours of reading/tired eyes (college text studying, ya'll know what I mean, the long hours it takes to read chapters of a boring text, college or not, but required reading) then to wake up one a.m. not able to see any reading material (on the third day of Tequin) remember I shared with ya'll that I kept telling my body felt like it was soaking in an acid pit, wonder if the excess acid fried my eyes or my Brain, grin. (sic)

Based on my experience with the ADR to Levaquin, it takes at least 3 years to be able to live/perform a near normal life! (sic)

Even after 3 years, symptoms still exist, ie., numb toes, pain in ankles, burning (eyes, mouth, skin), visual problems, passing pain in back of hands and lower arms, and at times - imbalance in walking, My left eyelid is droopy also and my right eyelid tight. My left pupil is dilated and everything is a bit fuzzier than usual. My eyes are strained when looking at the computer screen too long. I have problems with bright lights, everything seems too bright. I also have a twitch in my left eye. I think I need some tests to see what damage has been done.(sic)

For the past four months since taking my last Tequin, my left eyelid has been drooping...My eyes don't look the same. My vision has been "dimmer" (need more lights turned on in the house), eyes get tired more easily, as well has continuing to have no strength in my hands (and joint pain in the hands and fingers). I recognized the joint pain and weakness as Tequin (sic)

I would like everyone who has had blind spots develop in their eyes since taking fluoroquinolones to email me and tell me about them. On New Year's Eve I noticed a small area in the vision of my right eye was blind. As I read a small portion of the word above the one I was reading would turn white like the paper I was reading. On Wednesday, January 2, I saw my opthamologist who referred me to a retina specialist. The retina specialist was sure I had an autoimmune disease because this type of vision loss is usually associated with either arthersclerosis (older people) or retinal vasculitis (younger people). The results of the fluorescien photos of both eyes revealed nothing. He could not find an occlusion or inflamation, even at the sight of the loss. (sic)

Today I went through all the blood tests, etc. to completely rule out any autoimmune disease and specifically vasculitis. (sic)

I still have the vision loss. It has not changed in these 11 days. I am curious whether anyone else has had this. (sic)

Of interest is that my initial reaction and only time I have taken a fluoroquinolone was in October 2000. I still cycle with muscle fatigue and pain every few months. Twitching has become a small part of my life. (sic)


My field of vision would be white, as if I had looked into the sun too long and could not clear my eyes Has anyone experienced the same eye problems my wife is currently dealing with, namely nausea and dizziness whenever she finishes reading something or while watching t.v.? With the t.v. it seems to me like her eyes are telling her brain that she is moving even though she is perfectly still at the time. This then causes her to have motion sickness. I'm not a doctor but I just don't understand it any other way. (sic)

I have an increased number of floaters. I also have something like a dark sheer curtain effect that I see only when I move my eyes side to side while looking at a white surface or the sky. But the most troubling thing I have is a blind spot which occurred sometime around New Year's Eve. I noticed it while reading in bed. My left eye was covered by the pillow and I noticed a spot just above the centeral part of my vision was blanking out part of the letters. Somehow the blood flow to that small part of my retina was cut off for a short period of time. I have a "permanent" loss of sight there. I have had many appts with a retinal specialist and my internal medicine doctor to rule out what normally causes this.(sic)


The first symptoms I had right after taking Cipro were vision related. My eyes became very dry, and I saw flashes of light when I moved my eyeballs from side to side or up and down. The Opthamologist said that I had a "vitreous detachment". I also had large "floaters" in one eye that he said were cells torn off from the retina and optic nerve. Three years later, I still have this big gob of stuff in my eye that is like looking thru waxed paper, and it is especially difficult to see when the light is shining into that eye. My eyes are no longer dry, that lasted only about a month,and I also had droopy eyelids at the time too. It was also difficult to focus and make my eyes work together. All of those symptoms are gone, and I am left with the stuff in one eye, which gets no better (sic)

My eyes were tired and didn't focus well for quite some months after Cipro/Levaquin/naldixic acid/Floxin/Tequin - all in a 6 or 7 month period. In addition, I had eyelid problems - one eye twitched for over a month, and one eyelid drooped severely suddenly and the other drooped a little. The last problem has not resolved itself over two years later. (sic)

I did develop vision problems and had to get new glasses. I also fell and broke my arm nearly two years later because my depth of field is really screwed up and I misjudged the height of a curb.Anyway, I aged 20 years in two years after Levaquin. (sic)

. My blurry vision has stabilized to a degree I can see things a bit more clearly, however my eyes are not as reactive to light - I need more light to see things clearly. (sic)

I've been having a very bad twitch in my left eye and the pupil is continuously dilated. It seems every day brings a new problem. The left eye looks completely different from the right one, the eyelids don't match. Has anyone had eye problems? Do you have any info on what is happening that causes the twitch and dilation? (sic)

My eyesight was never good but now it's also a bit fuzzy.To refresh my history: I took 5 250 mg Levaquin pills (the last pill was taken on 5/29). This eye problem is one of many that I'm suffering. (sic)

Her other pronounced symptom is that she cannot stand any bright light and she has "pain behind her eyeballs". Friday the eye doctor gave her very dark glasses. Tomorrow she will have a series of eye exams. (The doctor did not want to do them Friday because of everything that had happened that week.) The doctor wants to know if this is a common reaction or a rare reaction, and if anyone has any insights into this reaction. Any information I can give her would be helpful to her. (sic)

For what it's worth, I went through two bouts of light sensitivity after being FQd. The first lasted weeks and happened a couple of months after the FQs. The second was another couple of months later, was not as intense and lasted about a week. No recurrences in the last three months. (Since being FQd I was light sensitive in months 3-5 and again at month 7. I am just finishing month 11.)(sic)

I too had problems with double vision. One on the many of my long list. I had the same treatment as you. My eyes are still not 100% normal as they are very sensitive to the light and my visual acuity is not what it was before being "floxed". Just thought I would let you know that you are not alone! (sic)

I have also had ongoing vision poblems, Rick describes them well but i never had a problem with bright light. I can see better in sunshine: it is fluorescent light, probably because of the pulsing, that drives me crazy. It is my right eye, and it has been that way off and on since April 1999 when I first took Levaquin. It gets better and then descends again unexpectedly. It is very distressing since my office is nothing but fluorescent lights. (sic)

Shortly after finishing a 9-day course of Levaquin, I developed double vision (diplopia). I had to take Methylprednisilone for 6 days. The neuro-opthalmologist says I have inflamed eye muscles, and possibly inflamed optic nerve (sic)

I have visual disturbances also, when I went to the ophthalmologist he told me that my eye sight was normal. This is the only thing that he found: "The peripheral retinal presented patches of white without pressure with glistening deposits at 2:00 o'clock and an apparent flap was questionable. Another patch of white without pressure was seen at 6:30. There was a radial glistening dots on it was seen at 6:30. There was a radial fold at 1:15 clockwise. A small patch of schisis-like with glistening dots on it was seen at 6:30 in the peripheral retina. A patch of white without pressure was visible at the lower temporal quadrant. " At the end of the report it says." He was also warned on increasing flashing lights and floaters and if present to seek eyecare right away." This doctor told me that he wanted to do lazer surgery on the white spots that he found, as a preventitive, but he specifically mentioned floters or flashing lights ( lightening bolts) as possibly signaling a problem.(sic)

The visual changes in me were a BIG increase in floaters (which are sloughed cells in the aqueous), a change in vison acquity, and increased sensitivity to light. (sic)

when I go to Wal-Mart my eyes burn and I have this kind of spaced out feeling and am really anxious to get out of there.(sic)

I was floxed over 18 months ago (Floxin), and have not been the same since in many ways. Since that time, I've worn glasses a lot, but I notice that when I do try to wear contacts now, I get pain in the eye within hours. Also a red spot shows up right next to my pupil (in either eye, and on the inside toward the nose). The next day, I cannot bear to wear them. I know the lenses are clean b/c they are one-day throw-aways. (sic)


Prior to this I wore contacts for 12 or 13 years without problem. I read on here that quinolones can show up in the "aqeuous humor of the eye"? Could this be what I'm experiencing? If someone has had this, what did you do about it? (sic)

I have had wierd visual problems like lots of floaters, and seeing things just wierd. Colors are too colorful? And black is too black? Strange. Has anyone actually found anything wrong with their eyes from their eye exams? (sic)

Cheri would be one of at least three people posting here who have had visual problems after being FQ'd. (sic)

I suffer from periodic attacks of silver shimmering spots in my visual field, combined on two occasions (for a couple of weeks each) with intense photosensitivity. Another report here included permanent (I believe) blind spots caused by shimmering areas. I don't have blind spots, I just have trouble seeing clearly. (sic)

In my case, I had my last photo-sensitivity episode around Christmas, and the shimmering is currently pretty good. (sic)

For what it's worth, my shimmering problem is clearly worse under fluorescent lights, and better in the sunshine.(sic)

My ophthalmologist (don't you hate trying to spell that) suggested that I might be having migraine visual auras without the headaches. That sounds fine to me, except that I never had them until about a month after I was FQ'd.(sic)

I call it "blurry vision" but that is really not a good description. My eye problem has three components. First, I become sensitive to light. I have trouble driving at night because headlights hurt my eyes. As you would expect, this is most noticeable at night. Second, there is a kind of shimmering brightness in the vision of my left eye. This has only happened twice, once around July 4 when my light sensitivity was the worst, and again this week. It's pretty scary. Third, I can feel my left eye. It isn't really pain, it's more like mild irritation. This gets worse and better, but it hasn't really gone away since I was FQ'd. This week it's very distinct. (sic)

Despite these problems, the vision in my left eye is only slightly worse than it was. In the summer of 1998 my correction in my left eye was about -3.75 and now it's about -4.00. My opthalmologist says that a quarter diopter is not a big change in a year, and is well within normal changes. Someone else who has posted here mentioned that she had been forced to get new optical prescriptions frequently (every month? every three months?) because her vision was deteriorating. This does not seem to be the case with me.(sic)

A short time after I was "floxed", I felt a strange sensation in my left eye too. I would be walking say down an aisle in the supermarket and I felt like my peripheral(?) vision was gone. I went to the opth. and he couldn't find anything wrong. I never mentioned the floxin to him because at that time I didn't know all I know now. My overall vision is terrible, yet when my eyes are checked, my reading glasses don't need to be changed. Everything is always blurry to me. (sic)

I posted early on in my Levaquin saga that my vision has been affected.I suddenly needed a new prescription shorty after I was FQ'd, then needed another change, this time a weaker prescription, 2 months later. I to had the floaters so thick they looked like cobwebs, now they are just little specks every so often. Mine to were said to be cause of my age. Never had them before the Fq's and they came on right after taking them. Streets lights and lights from cars really bother me I won't drive at night. (sic)

I only wore glasses to read before now I have to wear glasses for distant. Also my brain and my eyes don;t work well together, sounds weird but the only way I know how to explain it. I still have blurry vision and sometimes the ground is wavy. I also saw colors, long blue lines. I hate to write this it sounds so crazy. but it is the truth (sic)

I had asked the pharminfo net Dr about the quinolones He said that the FQ's could affect any organ.Would be interesting if some of you would go on the site and ask about the FQ's. Although they deny any long term affect. (sic)

I also suffer from visual disturbances similar to yours. You mentioned a shimmering brightness in the vision of your left eye but that it has only happened twice. I have three "blind" shimmering spots in the vision of my left eye that the opthamologist believes are the result of severe nerve irritation possibly caused by the two Levaquin tabs I took. However, these shimmering spots do not come and go; they have been there since the day I took the second tablet (March 20, 1999). I have also noticed a large area of occasional blurriness in the same eye that does come and go. I avoid driving at night if possible because I just don't feel that I can "see" as well as I did pre-FQ. (sic)

[all of the above are to be found within the indiviual post archived on the quinolone adverse drug reaction forum hosted by Yahoo.]
**********************************************************************

You may also find the following references to be of interest as well:

A small number of patients receiving fluoroquinolones developed visual disturbances including color distortion and diplopia (Ball, 1989). (sic)

Levaquin monograph
In clinical trials using multiple-dose therapy, ophthalmologic abnormalities, including cataracts and multiple punctate lenticular opacities, have been noted in patients undergoing treatment with other quinolones (sic)

Cipro monograph
May cause ophthalmologic abnormalities
Retinal degeneration (sic)

RAXAR™ Glaxo Wellcome Grepafloxacin HCl Antibacterial
Special Senses: amblyopia, conjunctivitis, deafness, dry eyes, ear disorder, eye pain, lacrimation disorder, parosmia,
photophobia, taste loss, tinnitus. (sic)

Floxacin Adverse Reactions:
The following adverse reactions have been reported in association with use of ofloxacin.
itching, foreign body sensation, photophobia, blurred vision, hyperaemia, chemical conjunctivitis/keratitis, periocular/facial oedema, dry eyes, eye pain (1-5% of treated eyes) and dizziness. These symptoms led to cessation of treatment in 1.6% of patients. (sic)


Effects of antibiotics on morphologic characteristics and migration of canine corneal epithelial cells in tissue culture.

Hendrix DV, Ward DA, Barnhill MA.

Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville 37901, USA.

OBJECTIVE: To determine effects of commonly used ophthalmic antibiotics on cellular morphologic characteristics and migration of canine corneal epithelium in cell culture. SAMPLE POPULATION: Corneal epithelial cells harvested from corneas of 12 euthanatized dogs and propagated in cell culture. PROCEDURE: Cells were treated with various antibiotics after a defect was created in the monolayer. Cellular morphologic characteristics and closure of the defect were compared between antibiotic-treated and control cells. RESULTS: Cells treated with ciprofloxacin and cefazolin had the greatest degree of rounding, shrinkage, and detachment from plates. Cells treated with neomycin-polymyxin B-gramicidin and gentamicin sulfate had rounding and shrinkage but with less detachment. Cells treated with tobramycin and chloramphenicol grew similarly to control cells. On the basis of comparisons of defect circumference between control cells and cells exposed to antibiotics, tobramycin affected cellular migration the least. CONCLUSIONS AND CLINICAL RELEVANCE: Effects of ciprofloxacin and cefazolin on morphologic characteristics of canine corneal epithelial cells in vitro should be taken into consideration before using these antibiotics for first-line of treatment for noninfected ulcers. Of the antibiotics tested that have a primarily gram-negative spectrum of coverage, gentamicin inhibited corneal epithelial cell migration and had greater cytopathologic effects than tobramycin did. For antibiotics with a gram-positive coverage, chloramphenicol had no cytopathologic effects on cells in comparison to cefazolin, which caused most of the cells to shrink and detach from the plate. Polymyxin B-neomycin-gramicidin was midrange in its effects on cellular morphologic characteristics and migration. (sic)

Corneal ulcer associated with deposits of norfloxacin.

Konishi M, Yamada M, Mashima Y.

Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.

PURPOSE: To report a case of corneal ulcer associated with deposits of norfloxacin. METHOD: Case report. A 40-year-old man with right trigeminal and facial nerve palsies and decreased tear secretion developed a corneal ulcer with white deposits in the right eye. The deposits were removed and analyzed by high-performance liquid chromatography. RESULTS: High-performance liquid chromatography results disclosed that the deposits on the corneal surface had the same retention time as norfloxacin. The patient discontinued norfloxacin ophthalmic solution and recovered successfully. CONCLUSION: Clinicians should be aware that frequent applications of topical norfloxacin in patients with decreased tear secretion may result in deposition of the drug on the cornea.(sic)


Ciprofloxacin microprecipitates and macroprecipitates in the human corneal epithelium.

Eiferman RA, Snyder JP, Nordquist RE.

Research Service, Veterans Administration Medical Center, Louisville, Kentucky, USA. reiferman@cs.com

In 4 corneal transplantation patients treated preoperatively with ciprofloxacin ophthalmic drops, microprecipitates associated with damaged corneal epithelium were noted in 2 patients. Another patient developed a large macroprecipitate in a corneal ulcer. All specimens were examined by electron microscopy and high-pressure liquid chromatography. The crystalline precipitates were pure ciprofloxacin. The macroprecipitate demonstrated a large zone of inhibition on agar plates seeded with a susceptible organism at 24 and 48 hours. It was bioactive and bioavailable in vitro. (sic)



"...received approval from the U.S. Food and Drug Administration (FDA) to
market its Vigamox antibiotic solution (moxifloxacin 0.5%) for the treatment
of bacterial conjunctivitis. "(sic)

"In four studies, 336 pediatric patients and 392 adults had no safety
concerns or adverse events that were significantly different from placebo.
Silver LH, Burkey R, Montgomery D, Gower L, Dickerson J, Crenshaw K, Potts S,
Gross R, Schlech B. Safety of ophthalmic moxifloxacin in the treatment of
newborns, infants and toddlers, children and adolescents with bacterial
conjunctivitis. ARVO 2003; Abstract 804"(sic)

"no safety concerns", yet when we look at Ofloxacin (another ophthalmic
fluoroquinolone) we find the following:

"ADVERSE REACTIONS
Ophthalmic Use
The most frequently reported drug-related adverse reaction was
transient ocular burning or discomfort. Other reported reactions
include stinging, redness, itching, chemical
conjunctivitis/keratitis, periocular/facial edema, foreign body
sensation, photophobia, blurred vision, tearing, dryness, and eye
pain. Rare reports of dizziness have been received." (sic)

Yet Silver et al claims that there were "no safety concerns or adverse events
that were significantly different from placebo". I am sure that a one year old child had
no problem bringing all of the above to Silvers attention once they
manifested.

"Dr. Mark Daniell and colleagues, from the University of Melbourne, reviewed
the medical records of 138 patients with bacterial corneal ulcer. Of these,
54 were treated with fluoroquinolone and 84 were treated with tobramycin
1.3% plus cefazolin 5%.
The two therapies were equally effective in treating the condition in terms
of visual outcome, the researchers found. However, serious complications
such as corneal perforation, evisceration, or enucleation of the affected
eye occurred in 16.7% of patients receiving fluoroquinolone, compared with
only 2.4% of patients receiving fortified antibiotic therapy. The authors
estimated that patients taking fluoroquinolone had an 8.9-fold increased
risk of serious complications." (sic)

Now who is lying here? Daniell or Silver?

Based upon Dr. Daniell's research one would then assume that 16.7% of these
kids are taking a substantial risk with none of the benefits. What makes them think that this product will be any different from levofloxacin, ofloxacin, or any other fluoroquinolone?

Levofloxacin ophthalmic solution is an antibiotic used to treat eye
infections.
Tell your doctor if any of these symptoms are severe or do not go away:
vision problems (e.g. blurry vision)
fever
burning eyes
eye pain
light sensitivity
sensation of a foreign body in the eye
headache
dry eyes
swelling eye lids
sore throat
If you experience any of the following symptoms, call your doctor
immediately:
skin rash
itching
hives
difficulty breathing or swallowing
swelling of the face or throat (sic)

But of course it cannot be the drugs, Silver et al says they have "no safety concerns or adverse events that were significantly different from placebo". Yet Dr. Daniell's research contradicts these statements.

Enrofloxacin-associated retinal degeneration in cats.

Gelatt KN, van der Woerdt A, Ketring KL, Andrew SE, Brooks DE, Biros DJ, Denis HM, Cutler TJ.

Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Box 100126, University of Florida, Gainesville, FL, USA. Gelattk@mail.vetmed.ufl.edu

OBJECTIVE: The objective of this study was to evaluate the possible relationship between the administration of parenteral and/or oral [corrected] enrofloxacin and the onset of acute retinal degeneration in cats. The animals studied included 17 cats that received systemic enrofloxacin and developed retinal degeneration soon thereafter. PROCEDURES: In this retrospective clinical study, cats that received parenteral and/or oral [corrected] enrofloxacin and developed acute blindness were identified. Parameters recorded included breed, age, sex, enrofloxacin dosage (daily dose and number of days administered), medical condition for which the antibiotic had been prescribed, ophthalmic signs, examination results, and the visual outcome. Fundus photographs were obtained in seven cats, and electroretinography was performed in five cats. Histopathology was performed on two eyes from one cat (case 1) that received enrofloxacin 5 months previously and developed retinal degeneration. RESULTS: All cats were the domestic shorthair breed; seven were females (one neutered) and ten were males (seven castrated). Ages ranged from 3 to 16 years old (mean +/- SD; 8.8 +/- 4.6 years). The medical disorders for which enrofloxacin was administered ranged from lymphoma and pancreatitis to otitis and dermatitis, and eight cats had urinary diseases. The daily and total dosage of enrofloxacin and number of days of administration were also highly variable. Presenting clinical signs were most often mydriasis and acute blindness. All cats had diffuse retinal degeneration as evidenced by increased tapetal reflectivity and retinal vascular attenuation. Absence of recordable electroretinographic responses suggested diffuse and extensive outer retinal disease. Vision returned in a few cats, but the retinal degeneration persisted or even progressed. Histopathology of two eyes revealed primarily outer retinal degeneration, with diffuse loss of the outer nuclear and photoreceptor layers, and hypertrophy and proliferation of the retinal pigment epithelium. CONCLUSION: Parenteral and/or oral [corrected] enrofloxacin is potentially retinotoxic in some cats, and may result in acute and diffuse retinal degeneration. Blindness often results, but some cats may regain vision. Practitioners should adhere closely to the manufacturer's current enrofloxacin dosage recommendation (5 mg/kg q 24 h), and continue clinical observations for this drug toxicity in cats.(sic)

PMID: 11422990 [PubMed - indexed for MEDLINE]

Ophthalmotoxicity and ototoxicity of the new quinolone antibacterial agent levofloxacin in Long Evans rats.

Nomura M, Yamada M, Yamamura H, Kajimura T, Takayama S.

Drug Safety Research Center, Daiichi Pharmaceutical Co., Ltd., Tokyo, Japan.

An ophthalomo- and ototoxicity study of a new quinolone antibacterial agent, (-)-(S)-9-fluoro-2,3-dihydro-3-methyl-10-(4-methyl-1- piperazinyl)-7-oxo-7H-pyrido[1,2,3-de] [1,4]benzoxazine-6-carboxylic acid hemihydrate (levofloxacin, DR-3355, CAS 100986-85-4) was investigated in Long Evans rats. The rats were orally administered 100 mg/kg of DR-3355, ciprofloxacin (CPFX), norfloxacin (NFLX) or nalidixic acid (NA) for 2 weeks, and the effects on visual and auditory functions were examined. Examination of electroretinograms (ERGs) revealed a decrease in the amplitudes of the a- and b-waves, a prolongation of the latency and diminution or disappearance of oscillatory potential waves in NA treated rats. Similar but milder changes were also noted in the NFLX treated rats. ERGs from DR-3355 or CPFX treated rats were normal. Histopathological examination revealed no changes suggestive of ophthalmotoxicity or ototoxicity in the rats treated with DR-3355, CPFX or NFLX. On the other hand, NA treated rats showed partial loss of the outer hair cells of the organ of Corti in the cochlea, suggesting that NA had slight ototoxicity. DR-3355 did not show any deleterious visual or auditory effects at the dose used in this study.(sic)

From the drug monograph for ciprofloxacin (Cipro):

Special Senses: Blurred vision, disturbed vision (change in color perception, overbrightness of lights), decreased visual acuity, diplopia, eye pain, tinnitus, hearing loss, bad taste.(sic)

From the monograph for ofloxacin (Floxin)
The most frequently reported drug-related adverse reaction was transient ocular burning or discomfort. Other reported reactions include stinging, redness, itching, chemical conjunctivitis/keratitis, periocular/facial edema, foreign body sensation, pHotopHobia, blurred vision, tearing, dryness, and eye pain. Rare reports of dizziness have been received.
In clinical trials, the following events, regardless of relationship to drug, occurred in 1 to 3% of patients: Abdominal pain and cramps, chest pain, decreased appetite, dry mouth, dysgeusia, fatigue, flatulence, gastrointestinal distress, nervousness, pHaryngitis, pruritus, fever, rash, sleep disorders, somnolence, trunk pain, vaginal discharge, visual disturbances, and constipation.
Special Senses: diplopia, nystagmus, blurred vision, disturbances of: taste, smell, hearing and equilibrium, usually reversible following discontinuation.
In clinical trials using multiple-dose therapy, opHthalmologic abnormalities, including cataracts and multiple punctate lenticular opacities, have been noted in patients undergoing treatment with other quinolones. The relationship of the drugs to these events is not presently established.
CRYSTALLURIA and CYLINDRURIA HAVE BEEN REPORTED with other quinolones.(sic)

From the monograph for levofloxacin (Levaquin):
Events occurring at a frequency lower than 0.3% regardless of drug relationship but considered medically important include: abnormal coordination, abnormal dreaming, abnormal hepatic function, abnormal platelets, abnormal renal function, abnormal vision, acute renal failure, aggravated diabetes mellitus, aggressive reaction, anemia, angina pectoris, ARDS, arrhythmia, arthritis, asthma, bradycardia, cardiac arrest, cerebrovascular disorder, circulatory failure, coma, confusion, convulsions (seizures), coronary thrombosis, delirium, depression, diplopia, embolism-blood clot, emotionally lability, erythema nodosum, G.I. hemorrhage, granulocytopenia, hallucination, heartblock, hepatic coma, hypoglycemia, hypotension, impaired concentration, increased LDH, jaundice, leukocytosis, leukopenia, lymphadenopathy, manic reaction, mental deficiency, muscle weakness, pancreatitis, paralysis, paranoia, postural hypotension, pseudomembranous colitis, rhabdomyolysis, sleep disorders, speech disorder, stupor, syncope, tachycardia, tendinitis, thrombocytopenia, vertigo, weight decrease, WBC abnormal not otherwise specified.
In clinical trials using multiple-dose therapy, ophthalmologic abnormalities, including cataracts and multiple punctate lenticular opacities, have been noted in patients undergoing treatment with other quinolones. The relationship of the drugs to these events is not presently established.
Crystalluria and cylindruria have been reported with other quinolones.(sic)

[Color perception disorders after nalidixic acid absorption]

[Article in French]

Haut J, Haye C, Legras M, Demailly P, Clay C.

PMID: 4540395 [PubMed - indexed for MEDLINE]

Reversible visual loss in a patient receiving high-dose ciprofloxacin hydrochloride (Cipro)

Vrabec TR, Sergott RC, Jaeger EA, Savino PJ, Bosley TM.

Neuro-Ophthalmology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107.

Bilateral acute visual loss characterized by cecocentral scotomas and acquired dyschromatopsia developed in a patient receiving large oral doses of ciprofloxacin hydrochloride (Cipro). The visual defects improved after cessation of this antibiotic. To our knowledge, this association has not been described previously. The use of this medication in high doses must be accompanied by careful monitoring of optic nerve function.(sic)

PMID: 2374675 [PubMed - indexed for MEDLINE]

*********************************************************************

The preceding is but a very brief synopsis of the damage resulting from the careless scripting of these agents. You do a great disservice to both the patient and the physician by failing to make note of the real risk involved with fluoroquinolone therapy. I would hope that you would take the time and effort to present such findings to avoid such tragedies from being repeated in the future.

Within the AERS report summaries maintained by the FDA we find untold reports of severe vision damage associated with fluoroquinolone therapy including:

visual disturbances
vision blurred
visual activity reduced
eye pain
eyelid odema
eye disorders
diplopia
visual field defects
optic papillitis
eye movement disorders
cataracts
blindness
dry eye syndrome
eye swelling
eyelid disorders
eye haemorrhage
optic nerve disorders
optic atrophy
corneal erosion
cornel disorders
sjogrens syndrome
retinal vasculitis
retinal vascular disorders
retinal degeneration
retinal artery thrombosis
pupillary light reflex test abnormal
glaucoma
eyelid ptosis
eye puritus
eye inlflammation
eye injury
eye infection viral
optic nueropathy
optic nerve injury
opthalmoplegia
ocular hyperaemia
corneal opacity
corneal deposits

The author is correct that many questions regarding the newer generations remain to be answered, but they all have to do with the severe and non-abataing nature of the associated adverse reactions.

Respectfully submitted,


Director
Fluoroquinolnoe Toxocity Research Foundation
www.fqresearch.org
fqresearch@aol.com