From the Guidelines
Yes, sertraline can cause ocular side effects, although they are relatively uncommon. The most frequently reported ocular side effects include blurred vision, dry eyes, abnormal vision, and visual disturbances. Some patients may experience mydriasis (pupil dilation) or reduced tear production. In rare cases, more serious effects like increased intraocular pressure, angle-closure glaucoma, or visual field defects have been reported. These effects occur because serotonin receptors are present in ocular tissues, and sertraline's alteration of serotonin levels can affect these tissues.
Key Points to Consider
- Patients taking typical doses of sertraline (50-200 mg daily) who experience new or worsening eye symptoms should consult their healthcare provider.
- These symptoms often resolve with dose adjustment or medication discontinuation.
- Individuals with pre-existing eye conditions should inform their prescriber before starting sertraline therapy, as they may require closer monitoring.
- The evidence from studies 1 suggests that while sertraline can cause ocular side effects, the overall risk is relatively low, and the benefits of treatment often outweigh the risks.
Recommendations for Clinical Practice
- Healthcare providers should be aware of the potential for ocular side effects when prescribing sertraline and monitor patients accordingly.
- Patients should be educated about the potential risks and benefits of sertraline and encouraged to report any new or worsening eye symptoms.
- In cases where ocular side effects occur, healthcare providers should consider dose adjustment or alternative treatments to minimize the risk of serious complications.
From the FDA Drug Label
Patients should be advised that taking sertraline can cause mild pupillary dilation, which in susceptible individuals, can lead to an episode of angle closure glaucoma. 9 Visual problems eye pain changes in vision swelling or redness in or around the eye
Yes, sertraline can cause ocular side effects, including:
- Mild pupillary dilation
- Angle closure glaucoma (in susceptible individuals)
- Visual problems
- Eye pain
- Changes in vision
- Swelling or redness in or around the eye 2 2
From the Research
Ocular Side Effects of Sertraline
- Sertraline, a selective serotonin reuptake inhibitor (SSRI), has been associated with various ocular side effects, including mydriasis, angle-closure glaucoma, and maculopathy 3, 4, 5, 6, 7.
- Mydriasis, often transient and with no major consequences, can promote closure of angles in susceptible patients, leading to angle-closure glaucoma 3.
- Angle-closure glaucoma is a serious condition that has been mainly associated with tricyclic antidepressants (TCAs), low-potency antipsychotics, topiramate, and, to a lesser extent, SSRIs, including sertraline 3, 4, 5.
- Maculopathy, a rare but potentially serious side effect, has been reported in association with sertraline use, with only a few cases published in the literature 6, 7.
- Bull's eye maculopathy, a specific type of maculopathy, has been reported in two cases, with no improvement in visual acuity or retinal pigment epithelium after discontinuation of sertraline 7.
Mechanisms and Risk Factors
- The exact mechanisms of sertraline-induced ocular side effects are not fully understood, but may involve changes in intraocular pressure (IOP) and serotonin receptor interactions 4, 5.
- Patients with glaucomatous risk factors, especially those who are elderly, may be more susceptible to sertraline-induced ocular side effects, and ophthalmological consultations should be considered before starting and during treatment with sertraline 4.
- The knowledge of SSRIs individual tolerability, angle-closure predisposition, and critical IOP could be important goals able to avoid further and more dangerous ocular side effects 5.