Ophthalmic side effects of benzodiazepines: A narrative review of studies involving psychiatric patients

Benzodiazepines (BZDs) are commonly used for a range of psychiatric conditions; however, their ophthalmological adverse effects are frequently overlooked in clinical practice. This study reviewed the ocular adverse effects associated with BZDs, reported specifically from psychiatric settings. A literature search was conducted on PubMed and Google Scholar using the keywords “Benzodiazepines AND (Ocular side effects OR Ophthalmology side effects),” and articles that used BZDs for psychiatric indications were selected. We isolated 23 articles from our literature search. A wide range of ocular side effects of BZDs has been reported, including intraoperative floppy iris syndrome, blepharospasm, interruption of smooth-pursuit movement, glaucoma, visual field loss, and self-assessed visual deficit. Specific BZDs have limited literature on their ophthalmic side effects; reported ones include alprazolam and acute angle-closure glaucoma, lorazepam and reduced visual contrast sensitivity, clonazepam and toxic retinopathy, and diazepam and allergic conjunctivitis. Considering the impact on vision, these side effects can also be associated with psychological distress. All these highlight the need for caution in therapeutic practice. Considering the widespread use of BZDs in psychiatry, it is important to exercise caution while prescribing and to identify and monitor ocular side effects appropriately.