Reversible visual loss caused by combination therapy of alfuzosin and finasteride in a patient with uveitic glaucoma

Abstract

Purpose: To report a case of ischemic optic neuropathy caused by medication for benign prostatic hyperplasia (BPH).

Methods: The medical record of a patient who experienced gradual visual loss during the BPH medication was retrospectively reviewed.

Observations: A 60-year-old man who had uveitic glaucoma, presented with gradual decrease of visual acuity in the left eye over 3 months. There were no signs of increased intraocular pressure or recurrence of uveitis; however, the best-corrected visual acuity of the left eye had decreased from 20/20 to 20/70. Decreased color vision and a relative afferent pupillary defect were present in the left eye. The patient had been taking a combination regimen of alfuzosin and finasteride for the past 6 months to treat BPH. He reported experiencing frequent episodes of dizziness after starting the BPH medication. Under the impression that he had ischemic optic neuropathy due to systemic hypotension caused by the medication, we switched his regimen to a monotherapy of tamsulosin. After 1 month, the visual acuity and color vision of the left eye was recovered.

Conclusions: Optic nerves affected by glaucoma may be more vulnerable to systemic hypotension, resulting in an increased risk of further ischemic injury. Drugs that can induce systemic hypotension should be prescribed with caution to glaucoma patients.

Keywords::

• Alfuzosin
• finasteride
• ischemic optic neuropathy