Blurry vision with SSRIs

[FolieADeux]

Hi all,

I have a female patient in her late 50s who (very reluctantly) started taking lexapro for depression and has has significant benefit from it. She's been on it for a few months now but just told me that her vision became notably more blurry since she started this med. She had some age related changes in vision prior to starting lexapro and had used reading glasses before but said this was a pretty precipitous change.

I'm going to ask her to get an eye exam and am not concerned about acute angle closure glaucoma at the moment given it's been ongoing and she made no mention of pain, red eyes, or other symptoms (I'll screen more thoroughly when I see her today though and give her the info when to go to the ED.)

I haven't really encountered this SE with SSRIs before and frankly don't include vision related changes in my informed consent about SE (though I'll start...) I don't rx TCAs much but talk about blurry vision as a SE when I do, but apparently it happens not infrequently SSRIs, too.

So basically my question is about SE management. I don't really want to switch or discontinue the lexapro if I can help it, since it was a lot of work to have her agree to take any medication.

Have any of you encountered blurry vision with SSRIs before? If so, what have you found effective to manage it - eye drops for possible dry eye? Supplements? Any other tips or tricks? Thanks!

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[Stagg737]

Hi all,

I have a female patient in her late 50s who (very reluctantly) started taking lexapro for depression and has has significant benefit from it. She's been on it for a few months now but just told me that her vision became notably more blurry since she started this med. She had some age related changes in vision prior to starting lexapro and had used reading glasses before but said this was a pretty precipitous change.

I'm going to ask her to get an eye exam and am not concerned about acute angle closure glaucoma at the moment given it's been ongoing and she made no mention of pain, red eyes, or other symptoms (I'll screen more thoroughly when I see her today though and give her the info when to go to the ED.)

I haven't really encountered this SE with SSRIs before and frankly don't include vision related changes in my informed consent about SE (though I'll start...) I don't rx TCAs much but talk about blurry vision as a SE when I do, but apparently it happens not infrequently SSRIs, too.

So basically my question is about SE management. I don't really want to switch or discontinue the lexapro if I can help it, since it was a lot of work to have her agree to take any medication.

Have any of you encountered blurry vision with SSRIs before? If so, what have you found effective to manage it - eye drops for possible dry eye? Supplements? Any other tips or tricks? Thanks!

I have encountered this primarily with duloxetine and was distressing enough to those individuals to warrant changing meds. I'd be interested in others' thoughts here as well as this isn't something I've really encountered other than duloxetine.

 

[Trismegistus4]

I tried Lexapro once myself briefly years ago, and I noticed it dilated my pupils, which of course worsens near vision. I would ask whether she finds that only close vision, only distance vision, or both are blurry.

 

[Crayola227]

Always reasonable to try dry eye saline drops - preservative free single use sterile saline are the best as you rule out any issues with a reaction to the preservative which is not uncommon.

You'll know quickly if it's dry eye because this can help immensely.

The tear film accounts for something crazy like 20% of your refractive power? It's a lot is all I can recall.

Others will have more/better advice, but drops are a cheap and simple intervention that can actually make a huge difference if dry eye is part of this.

This advice sort of goes any time you have blurry vision you suspect may be dry eye or have a dry eye component as a med SE, provided you consider and rule out more serious causes.

 

[FolieADeux]

Seems like dry eye is the first thing to assess for and treat. Somewhat surprised I hadn't encountered this earlier given the number of people on antidepressants who are also on screens all day long (also a big factor in dry eye.) Pupil dilation also seems to be a not uncommon thing with SSRIs.

If dry eye tx doesn't help the blurriness I'll encourage eye exam and/or antidepressant switch and will try to remember to update. Thanks for the input everyone!

 

[allantois]

I just had a patient who complained about intermittent blurry vision/dry eye but only in one eye on Paxil 10 mg (he’s had multiple side effects with different SSRIs). I sent him to see ophto but haven’t seen him back yet. I feel like everything gets blamed on psych drugs, and it’s a good idea to r/o some underlying medical pathology first before blaming it on the med

 

[mistafab]

I had a patient, very somatic anxious person who reported intermittent mild blurred vision typically at night on sertraline. I wrote it off due to the numerous clearly hypersomatic foci. The patient later admitted they may have convinced themselves they had it after reading that it was a potential side effect.

Who knows, maybe they did have it. I offered eye drops but it didnt bother them so they weren't interested.

 

[Desired Member]

I had a patient develop blurry vision after starting lexapro which was worse when going from darkness to light, etc. It started when going up on dose from 10mg to 15mg. They went to eye dr. and reportedly had a normal eye exam. Patient experienced benefit with lexapro so wanted to try continuing it rather than switching med. If i remember correctly, went down to 12.5mg daily. I never saw patient again.

 

[allantois]

I had a patient, very somatic anxious person who reported intermittent mild blurred vision typically at night on sertraline. I wrote it off due to the numerous clearly hypersomatic foci. The patient later admitted they may have convinced themselves they had it after reading that it was a potential side effect.

Who knows, maybe they did have it. I offered eye drops but it didnt bother them so they weren't interested.

Oh I forgot to add that I will often ask patients if they develop these side effects after reading about them online. I’m convinced I have more patients develop HAs as a s/e because that’s one side effect I usually mention with medications

 

[allantois]

I had a patient develop blurry vision after starting lexapro which was worse when going from darkness to light, etc. It started when going up on dose from 10mg to 15mg. They went to eye dr. and reportedly had a normal eye exam. Patient experienced benefit with lexapro so wanted to try continuing it rather than switching med. If i remember correctly, went down to 12.5mg daily. I never saw patient again.

Never saw them again

 

[Jules A]

Female mid 40s on Zoloft 50mg. Worked well for anxiety but she reported blurry vision. I was doubtful it was due to Zoloft but it cleared up after discontinuing.

 

[Kissmyabjj]

I have taken Lexapro for years and I can attest to this effect. It doesn’t bother me so much anymore, but when we increased my dosage a few years back I reached out to my psychiatrist about it.

 

[Dr.MONO]

I have taken Lexapro for years and I can attest to this effect. It doesn’t bother me so much anymore, but when we increased my dosage a few years back I reached out to my psychiatrist about it.

Is it dose dependent?

 

[Alemo]

Is there cross-reactivity or action at cholinergic receptors with SSRIs? I know Paxil is anticholinergic, but not sure about the relative degrees of the others….

 

[FolieADeux]

Is there cross-reactivity or action at cholinergic receptors with SSRIs? I know Paxil is anticholinergic, but not sure about the relative degrees of the others….

Anticholingeric effects causing changes in accommodation seems to be the leading theory. I found this interesting optometry article (granted its a few years old but fairly informative) that was a decent overview on the ocular impacts of our meds.

Also found a case study re cycloplegia (paralysis of the ciliary muscles involved in lens accommodation) with duloxetine.

Still surprised this hadn't come up at all in training or patient care till now since it seems not uncommon.

The Mind's Eye: Ocular Complications of Psychotropic Medications

https://www.tandfonline.com/doi/full/10.1080/24750573.2017.1333264

 

[FolieADeux]

Is it dose dependent?

For my patient at least, she said she had mild blurring when we first started lexapro which she got used to, but it came up again because the blurriness worsened with the recent dose increase. So, n of 1 but I wouldn't be surprised if it was dose dependent.