When prescribing or recommending treatments to patients, optometrists should remember what every clinician and health professional knows – drugs and treatments have side effects. An obvious statement perhaps, although sometimes overlooked, with potentially serious results, as shown in a case investigated earlier this year.

A 61-year-old patient in Manchester experienced a weeks-long psychotic episode after he was prescribed prednisolone (see Prednisolone details, overleaf) in 2022 by Manchester Royal Eye Hospital following loss of vision in his left eye and a severe infection in his right eye.

Prednisolone can cause some side effects immediately, such as stomach upset or mood changes including hallucinations, while others, such as getting a “moon face” (possible sign of Cushing’s syndrome), can happen after weeks or months (NHS England, 2024 ). 

The man in question – Andrew Holland – complained to England’s Parliamentary and Health Service Ombudsman Rebecca Hilsenrath, who said in April 2024 that although she had found no failings with the NHS trust in prescribing steroids for the patient’s eye condition, there had been a “missed opportunity” to fully inform him of potentially extreme side effects. He was therefore unable to make a fully informed decision on whether to take them or not.