Dear Editor,
In the ophthalmological field, the side effects that could occur following prolonged periods of taking Proton Pump Inhibitors (PPIs) are not always adequately considered.
In addition to the lack of absorption of certain vitamins, which are particularly important for the function of the retina, there are reports that also include other ocular side effects.
The high number of the PPI prescriptions, and the increased likelihood of long-term use have raised concerns over unexpected adverse reactions (ADRs). It was demonstrated that the PPI pharmacology may not be limited to local inhibition of H-K-ATPase pump in parietal cells in the stomach [1,2]
Some patients may have a high risk of developing memory impairment, neuropathy, hearing and visual impairment, or migraines from taking PPIs. [3]
Proton pump inhibitors (PPIs), antiglaucoma and anticholinergic medications are significantly associated with dry eye symptoms, according to a study published in The Ocular Surface.[4]
This study underlines that medication use is highly informative of risk of dry eye symptoms. The novel link between PPIs and dry eye symptoms deserves particular attention given how commonly they are prescribed.
Finally, a recent study is expected to increase physician awareness of the potential association between the use of PPI/H2 blockers and ocular toxoplasmosis. Studies should be continued to investigate the mechanism of action underlying these findings. Further study would be useful to determine whether continued use of PPIs increases the risk of ocular toxoplasmosis reactivation.[5]
References:
[1] Shin, J. M. & Sachs, G. Pharmacology of proton pump inhibitors. Curr Gastroenterol Rep 10, 528–534 (2008).
[2] Shin, J. M., Munson, K., Vagin, O. & Sachs, G. The gastric HK-ATPase: structure, function, and inhibition. Pflugers Arch 457, 609–622, https://doi.org/10.1007/s00424-008-0495-4 (2009).
[3] Makunts, T., Alpatty, S., Lee, K.C. et al. Proton-pump inhibitor use is associated with a broad spectrum of neurological adverse events including impaired hearing, vision, and memory. Sci Rep 9, 17280 (2019). https://doi.org/10.1038/s41598-019-53622-3
[4] Wolpert LE, Snieder H, Jansonius NM, Utheim TP, Hammond CJ, Vehof J. Medication use and dry eye symptoms: A large, hypothesis-free, population-based study in the Netherlands. Ocul Surf. 2021 Oct;22:1-12. doi: 10.1016/j.jtos.2021.06.009. Epub 2021 Jun 23. PMID: 34171471.
[5] Conrady CD, Pradeep T, Yu Y, Johnson MW, VanderBeek BL. Association of Proton Pump Inhibitor/Histamine-2 Blocker Use and Ocular Toxoplasmosis: Findings from a Large US National Database. Ophthalmol Retina. 2023 Mar;7(3):261-265. doi: 10.1016/j.oret.2022.08.023. Epub 2022 Sep 2. PMID: 36058521; PMCID: PMC9978037.
Proton pump inhibitors and ophthalmological side effects.