Minocycline

  • Antibiotic derived from tetracycline used against wide variety of bacteria
  • Treats refractory acne vulgaris
  • Most common ophthalmic side effect: papilledema (from increased intracranial pressure)
  • Headache, neck pain, transient or persistent loss of vision, and...
  • Loss of vision even WITHOUT headache or other symptoms
  • Symptoms begin within weeks to months after starting standard doses of minocycline
  • Swollen optic discs (papilledema)
  • Visual fields abnormal, reflecting axonal damage from chronically elevated intracranial pressure
  • Brain imaging normal
  • Lumbar puncture discloses high opening pressure and normal cerebrospinal constituents
  • Isotretinoin-induced increased intracranial pressure
  • Idiopathic intracranial hypertension (pseudotumor cerebri)
  • Brain tumor
  • Meningitis
  • Hydrocephalus
  • Optic neuritis
  • Ischemic optic neuropathy in giant cell arteritis
  • Compressive or infiltrative optic neuropathy from cancer
  • Refer promptly to ophthalmologist any patient with visual symptoms and/or headache who is using minocycline
  • Consider baseline ophthalmologic screening and routine screening every 3-6 months because papilledema can exist at first without causing visual symptoms
  • Vision loss may be delayed because axonal damage in papilledema proceeds slowly and initially spares visual acuity
  • Vision loss reversible if papilledema detected early
  • Vision loss permanent and disabling if papilledema detected late