Table 2
Ocular side effects of antirheumatic medications
DrugNon-infectious side effectsInfectious side effectsReferences
AzathioprineRetardation in corneal wound healing in albino rabbitsCMV retinitis, ocular toxoplasmosis reactivation6–8
MethotrexatePruritus, burning, irritation, blurred vision, conjunctivitis, dry eyes, blepharitis, internuclear ophthalmoplegia, optic disc swelling, visual field defects, intraocular lymphoma, retinal cotton wool spots, corneal epitheliopathyNone reported9–21
Mycophenolate mofetilNone in vivo; toxicity to retinal pigment epithelium in vitroNone reported23
LeflunomideCystoid macular oedemaNone reported25
CiclosporinPotentiate steroid-induced cataractsCMV anterior uveitis27–31
CyclophosphamideBlurred vision, conjunctivitis, tearing, pruritus, burning of the eyes, soreness, grittiness, dryness, increased lacrimation, bilateral punctal stenosisNone reported33–35
SulfasalazineTransient myopiaNone reported38
ApremilastNone reportedNone reported
BaricitinibNone reportedNone reported
TofacitinibNone reportedNone reported
TNF inhibitorsParadoxical reactions (uveitis, sarcoid uveitis, sarcoid-like granulomatosis and scleritis)
Demyelinating conditions (GBS, MFS, MS-like syndromes, optic neuritis, internuclear ophthalmoplegia, homonymous hemianopia, nystagmus, diplopia, visual field defects and scotomas)
AdalimumabDiffuse retinopathy, central retinal vein occlusion, peripheral corneal infiltrates, acute retinal necrosisNecrotising group A streptococcal periorbital infection, orbital abscess59–64
CertolizumabShares side effects from TNF inhibitors class. No other reports found.None reported
EtanerceptAcute ocular myositis, angioedema of the periorbital region, primary Intraocular lymphomaPostoperative eyelid infection, TB uveitis, HHV6 uveitis, bilateral candida chorioretinitis, toxoplasmic chorioretinitis65–73
GolimumabMerkel cell carcinoma of the eyelidNone reported74
InfliximabRetinal vein thrombosis, rosacea keratitisEndogenous endophthalmitis, endophthalmitis associated with Purpureocillium lilacinum, orbital cellulitis, CMV retinitis, toxoplasmic chorioretinitis75–84
AnakinraNystagmusNone reported85
CanakinumabNone reportedNone reported
SarilumabWorsening uveitis and retinal infiltratesNone reported86
TocilizumabFulminant bilateral papilloedemaHTLV-1 uveitis, viral conjunctivitis, ophthalmic herpes zoster infection87–90
UstekinumabNone reportedOphthalmic herpes91
SecukinumabNone reportedEndogenous endophthalmitis93
IxekizumabNone reportedNone reported
RituximabRetinal necrosis, conjunctivitis, macular oedema, transient IOP elevations and iridocyclitis with mutton-fat keratic precipitatesCMV retinitis95–100
AbataceptNone reportedInfectious cornea ulcer102
Interferon alphaOcular retinopathy, non-arteritic anterior ischaemic optic neuropathy, neuromyelitis optica, optic neuritis, cystoid macular oedema, Vogt–Koyanagi–Harada disease, abducens palsy, oculomotor nerve palsy, glaucoma, retinal vein thrombosisNone reported105–129
  • CMV, cytomegalovirus; GBS, Guillian-barre Syndrome ; HHV6, human herpesvirus 6; HTLV-1, human T-cell leukaemia-lymphoma virus 1; IOP, intraocular pressure; MFS, Miller Fisher Syndrome; MS, Multiple Sclerosis; TB, tuberculosis; TNF, tumour necrosis factor.