Nystatin and Ocular Side Effects
Nystatin does not cause eye side effects because it has minimal to no systemic absorption when used topically or orally, remaining localized to the site of application. 1, 2
Mechanism and Safety Profile
Nystatin works through direct contact with fungal cells at the application site and is not systemically absorbed, which eliminates the potential for ocular or other systemic adverse effects 2
The drug's excellent safety profile stems from this minimal systemic absorption, making it safe for topical use in treating candidal infections of the skin, mucous membranes, and vaginal tissues 2
The only documented adverse reaction to nystatin is rare cutaneous hypersensitivity at the site of application—no ocular side effects have been reported in clinical guidelines 1
Clinical Context
Nystatin is recommended for oral candidiasis (400,000-600,000 units four times daily for adults), vaginal candidiasis (100,000-unit tablets daily for 14 days), and cutaneous candidiasis, all without systemic side effects 3, 1
When used as oral suspension, nystatin does not appreciably affect systemic parameters (such as INR in warfarin users), further confirming its lack of systemic absorption 3
The primary safety concern with nystatin is limited to potential necrotizing enterocolitis in premature infants when used orally—not ocular toxicity 2
Comparison with Systemic Antifungals
Unlike systemic azole antifungals (fluconazole, voriconazole, itraconazole) that can cause various systemic side effects due to their absorption and CYP450 interactions, nystatin remains localized 3
Research on parenteral nystatin formulations has explored systemic use, but standard topical/oral nystatin preparations used in clinical practice do not achieve systemic levels that would cause ocular or other distant organ effects 4, 5