Severe Adverse Ocular Reactions
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The incidence of ocular complications from hormonal contraceptives was estimated to be 1 in 230,000 users (1).
Therefore, severe adverse vascular accidents of the eye are exceptional in women under 40 years and without risk factors (2). Spasm of the central retinal artery, generally precedes occlusion and requires immediate ophthalmologic examination and discontinuation of COC s. On the contrary, this event lead to loss of sight and functional recuperation in unusual (3,4,5).
In fact, acute retinal arterial vascular occlusive disorders represent the more important cause of blindness or serious impaired vision ; although, their pathogenesis is hitherto a controversial issue (6,7).
Venous occlusion occurs less suddenly and involves a less extensive loss of sight. The prognosis depends on the affected area. Symptomatology of the ophthalmic vein thrombosis may be variable: unilateral proptosis,haemorrhagic retinopathy and,increase in intraocular pressure can be differently associated. There is a complete resolution of the vein thrombosis and eye signs and symptoms with the discontinuation of the hormonal contraceptive (8).
Therefore, these worned vascular effects in women taking hormonal contraceptives are very rare (9,10). The risk is affected by smoking, irregular lipid and glucose metabolism,and hypertension.
Although ocular complications are unusual, they should be kept in mind and women with a history of vascular problems,visual problems ,or migraines should be excluded before COCs are prescribed. Particularly, migraine should be considered a warning signal (11).
Retinal disorders have been more common in women who complained of headache .However, the incidence of these complications seems to lesser with the estrogen -dose reduction and the use of third-generation progestins (12).
Other conditions as the isolated retinal bleeding and vascular papillitis,are reversed on termination of COCs use. The more rare macular edema have been reported but the data resulted insufficient to permit a casuality relationship with COCs.
Retrobulbar optic neuropathy in young women may be considered as the first manifestation of a sclerosis. Ophthalmic migraines are,also,reported in sporadic cases (13).
However, experimental studies on the ocular effects of oral contraceptives in animals showed only increased permeability of the lens and possibly vascular dilatation (14). Possible aetiopathogenetic interrelations between hormonal contraceptives and ocular side-effects are still controversial; however, when the HC –user reports a vision decrease or persistent or recurrent headache it is convenient that hormonal contraception is discontinued (15).
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Rosa Sabatini and Giuseppe Loverro
Dept. Obstetrics and Gynecology,
General Hospital Policlinico-University of Bari, Italy
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REFERENCES
[1] Leff, S.P. (1976). Side-effects of oral contraceptives:occlusion of branch artery of the retina. Bull.Sinai Hosp. Detroit, 24(4), 227-9.
[2] Rekhi, G.S., Dheer, S. (2002). Oral contraceptive-induce central retinal artery occlusion. J. Assoc. Phisicians India, 50,1084-5.
[3] Mehta, C. (1999). Central retinal artery occlusion and oral contraceptives. Indian J. Ophthalmol, 47(1), 35-6.
[4] Blade, J., Darleguy, P., Chanteau, Y. (1971). Early thrombosis of the retinal artery and oral contraceptives. Bull. Soc. Ophtalmol, 71(1), 48-9.
[5] Girolami, A., Vettore, S., Tezza, F., Girolami, B. (2007). Retinal central artery occlusion in a young woman after ten days of a drospirenone-containing oral contraceptive. Thromb. Haemost, 98(2), 473-4.
[6] Hayreh, S.S. (2005). Prevalent misconceptions about acute retinal vascular occlusive disorders. Prog.Retin. Eye Res, 24 (4), 493-519.
[7] Blade, J., Darleguy, P., Chanteau, Y. (1971). Early thrombosis of the retinal artery and oral contraceptives. Bull. Soc. Ophtalmol, 71(1), 48-9.
[8] Jaais, F., Habib, Z.A. (1994). Unilateral superior ophthalmic vein thrombosis in a user of oral contraceptives. J. Med. Malaysia, 49(4), 416-8.
[9] Villatte-Cathelineau, B. (1985). The eye and hormones:vascular disorders associated with combined oral contraceptives and pregnancy. Contracept. Fertil. Sex(Paris), 13(1), 147-52.
[10] Villatte-Cathelineau, B. (1985). The eye and hormones:vascular disorders associated with combined oral contraceptives and pregnancy. Contracept.Fertil. Sex(Paris), 13(1), 147-52.
[11] Asensio Sànchez, V.M., Pèrez Flandez, F.J., Bartolomè Aragon, A., Gil Fernandez, E. (2002). Ophthalmologic vascular occlusions and oral contraceptives. Arch. Soc.Esp. Oftalmol, 77(3), 163-6
[12] Glacet-Bernard, A., Kuhn. D., Soubrane, G. (1999). Ocular complications of hormonal treatments:oral contraception and menopausal hormonal replacement therapy. Contracept.Fertil.Sex, 27(4), 285-90.
[13] Hayreh, S.S. (2005). Prevalent misconceptions about acute retinal vascular occlusive disorders. Prog.Retin. Eye Res, 24(4), 493-519.
[14] Malek, N., Lebuisson, D.A. (1992). Adverse ocular reactions to oral contraceptive use. Contracept. Fertil. Sex(Paris), 20(4), 441-4.
[15] Wood, J.R. (1977). Ocular complications of oral contraceptives.Ophthalmic.Semin, 2(4), 371-402.
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