May 20, 2002
Acute Psychosis Following the Use of Topical Ciprofloxacin
Arch Ophthalmol 2002 May;120(5):669-70
A healthy 27-year-old woman came to the emergency eye clinic with a 3-day history of bilateral reddened eyes associated with ecchymosis and swelling of the eyelids. The patient had no history of any systemic complaints, was taking no medication for therapeutic or recreational use, did not have alcoholism, and did not smoke. Conjunctival swabs were taken and sent for microbial isolation and sensitivity assays and the patient was prescribed ciprofloxacin eye drops, 1 drop hourly, in each eye. About a half hour after the third dose, the patient complained of dizziness and light-headedness. Following this, family members noted a distinct change in the behavior of the patient, who began to have well-defined visual hallucinations, ill-defined auditory hallucinations, and irrational conversation. The next day, the patient was seen in the emergency eye department with increasing behavioral problems. The patient was deemed to have had an acute psychotic reaction secondary to topical ciprofloxacin. The patient was advised to stop using ciprofloxacin eye drops (nearly 24 hours after initiation of treatment) and began taking teicoplanin (1%) eye drops. Within about 12 hours of changing the treatment, the patient and family members noted an improvement in behavior and within a further 12 to 14 hours, the hallucinations and behavioral disturbances disappeared completely. The patient was later able to describe her visual and auditory hallucinations in detail. The conjunctivitis responded completely to the teicoplanin regimen.
Ciprofloxacin hydrochloride is a fluoroquinolone antimicrobial frequently used in both ophthalmic and general medical practice. Whereas adverse effects of this drug are not uncommon following its systemic use, they are uncommon following its topical use. Central nervous system adverse effects, such as dizziness and lightheadedness, acute psychosis, and other neuropsychiatric disorders, have been described following its systemic use. Whereas psychotic reactions are well known after the use of atropine and cyclopentolate eye drops, this is the first reported case of such a reaction after the use of ciprofloxacin eye drops. Therefore, the possibility of such an adverse effect should always be kept in mind in patients using these drops, particularly in young women, who seem to be especially sensitive to these effects.
Posted by dastjerdi at May 20, 2002 06:48 PM