Can starting Megace (megestrol acetate) cause bilateral eye redness, erythema, and clear thin drainage?

Megace (Megestrol Acetate) and Bilateral Eye Redness

Starting Megace (megestrol acetate) could potentially cause bilateral eye redness, erythema, and clear thin drainage as these ocular symptoms are consistent with medication-induced conjunctivitis, though this is not a commonly reported side effect of the medication.

Evidence from Drug Label and Guidelines

• The FDA drug label for Megace lists "amblyopia" (impaired vision) under special senses adverse effects that occurred in 1-3% of patients in clinical trials 1
• Medication-induced keratoconjunctivitis can present with bilateral conjunctival injection (redness), watery or mucous discharge, which matches the symptoms described 2
• The British Association of Dermatologists guidelines note that systemic medications can cause mucocutaneous effects including ocular disturbances such as photophobia, xerophthalmia, and conjunctivitis 2

Possible Mechanisms

• Megace is a synthetic progestin that may affect ocular tissues through hormonal mechanisms 3
• Medication-induced conjunctivitis typically presents with bilateral redness, punctal edema, and watery discharge, similar to the symptoms described 2
• Systemic medications can cause ocular surface inflammation through direct irritation or immune-mediated mechanisms 2

Clinical Presentation of Medication-Induced Conjunctivitis

• Bilateral conjunctival injection (redness) is a classic sign of medication-induced ocular surface disorders 2
• Clear thin drainage is consistent with the watery discharge seen in medication-induced conjunctivitis 2
• Erythema of surrounding tissues can occur as part of the inflammatory response 2

Differential Diagnosis to Consider

• Allergic conjunctivitis: presents with bilateral redness, eyelid edema, watery discharge, and mild mucous discharge 2
• Viral conjunctivitis: can present with bilateral (often sequentially) redness and watery discharge 2
• Dry eye syndrome: can cause redness and reflex tearing 2

Management Recommendations

• If symptoms developed shortly after starting Megace, consider discontinuing the medication if medically appropriate 2
• Preservative-free ocular lubricants can help manage symptoms while determining if Megace is the cause 2
• Ophthalmology referral is recommended if symptoms persist or worsen despite discontinuation of the suspected medication 2

Important Considerations

• The temporal relationship between starting Megace and onset of ocular symptoms is critical in establishing causality 2
• If symptoms are severe or affecting vision, immediate ophthalmology evaluation is warranted 2
• Document the reaction for future reference, as rechallenge with the same medication may cause recurrence 2

Monitoring and Follow-up

• Monitor for resolution of symptoms after discontinuation of Megace 2
• If symptoms persist despite discontinuation, consider other etiologies and refer to ophthalmology 2
• If Megace must be continued for medical reasons, ophthalmology consultation can help manage ocular side effects 2

While ocular side effects are not among the most commonly reported adverse effects of Megace, medication-induced conjunctivitis remains a possible explanation for bilateral eye redness with clear discharge that develops after starting a new medication.