Ocular adverse effects associated with commonly prescribed urological medications - a narrative review of current evidence

Abstract Background: Medications commonly used in urology are among the most frequently prescribed therapies in adult and elderly populations. Although their adverse effects typically involve the cardiovascular, gastrointestinal or central nervous systems, growing evidence indicates that several of these drugs may also affect ocular structures, leading to symptoms that range from mild visual disturbances to intraoperative complications.Objective: To summarise current literature on ophthalmic adverse effects associated with commonly used urological medications, with emphasis on underlying mechanisms and clinical relevance.Methods: A narrative review was conducted using publications indexed in PubMed, Scopus and Google Scholar between 2000 and 2025, including original studies, observational analyses, case reports and meta-analyses.Results: The best-documented ocular complication is intraoperative floppy iris syndrome (IFIS), strongly linked to tamsulosin. Anticholinergic agents may cause accommodative difficulties and dry eye symptoms, and in predisposed individuals may trigger acute angle-closure glaucoma. Phosphodiesterase type 5 inhibitors most often lead to transient colour-vision disturbances and photophobia. Fluoroquinolones have been discussed in the context of a potentially increased risk of retinal detachment, although findings are inconsistent. Ocular reactions related to 5α-reductase inhibitors and mirabegron appear uncommon.Conclusions: Available evidence shows that the visual system represents an important, yet often overlooked, target of adverse reactions to urological therapies. Awareness of these associations may support early recognition of complications and improve treatment safety, especially in older patients or those with pre-existing ocular disease. Further prospective studies are needed to better define the frequency and mechanisms of these reactions.Keywords: urological medications; ocular adverse effects; intraoperative floppy iris syndrome; PDE5 inhibitors; anticholinergics; fluoroquinolones; visual system