What are the long-term effects of metoprolol on eyesight?

Long-Term Effects of Metoprolol on Eyesight

Metoprolol has no documented direct long-term effects on eyesight in most patients, though rare cases of visual hallucinations have been reported as an adverse effect. 1

Metoprolol and Visual System Effects

Metoprolol is a selective beta-1 adrenergic receptor blocker commonly used for various cardiovascular conditions including hypertension, angina, and heart failure. When examining its potential effects on vision:

Documented Visual Side Effects

The FDA drug label for metoprolol lists several central nervous system effects, but specifically mentions only a few visual-related adverse reactions:

• Blurred vision (reported as a miscellaneous side effect) 1
• Visual disturbances (reported during post-MI treatment, though drug relationship not clearly established) 1

Rare but Significant Visual Adverse Effects

1. Visual Hallucinations

   • Case reports document visual hallucinations in some patients taking metoprolol, typically manifesting as seeing people or objects that aren't present, particularly at night 2
   • These hallucinations resolved within days after discontinuation of metoprolol
   • This adverse effect may be underreported as patients might attribute these experiences to dreams or may be embarrassed to report them

2. Contrast with Other Beta-Blockers

   • Unlike some other beta-blockers (particularly propranolol, which is more lipophilic), metoprolol has fewer documented central nervous system effects affecting vision 2
   • Metoprolol does not appear to cause the ocular pigmentary deposits that can occur with certain psychotropic medications 3

Special Considerations

Therapeutic Use in Eye Conditions

Interestingly, beta-blockers have been investigated for potential therapeutic effects in certain eye conditions:

• Intravitreal metoprolol has been studied as a potential treatment for central serous chorioretinopathy (CSC) 4
• Other beta-blockers like metipranolol and topical metoprolol tartrate have been used to treat glaucoma and ocular hypertension 5, 6

Monitoring Recommendations

For patients on long-term metoprolol therapy:

• Be alert for any reports of visual disturbances, particularly visual hallucinations
• Consider metoprolol as a potential cause if a patient reports seeing people or objects at night that aren't present
• If visual hallucinations occur, discontinuation of metoprolol should be considered, with substitution of an alternative agent if necessary

Risk Factors for Visual Side Effects

No specific risk factors for metoprolol-induced visual disturbances have been clearly identified, though case reports suggest:

• Elderly patients may be more susceptible to visual hallucinations 2
• Patients with a history of cardiac arrest or other significant cardiac events may experience these effects 2

Clinical Management

If a patient on metoprolol reports visual disturbances:

1. Evaluate the nature and timing of visual symptoms
2. Consider discontinuation of metoprolol if visual hallucinations occur
3. Consider switching to an alternative beta-blocker with different lipophilicity (such as atenolol) if beta-blockade is still required 2
4. Monitor for resolution of symptoms after medication change

Unlike some other medications that can cause permanent retinal changes or corneal deposits, there is no evidence that metoprolol causes structural damage to the eye or permanent visual impairment when used at standard therapeutic doses.