Blurred vision has been a noted side effect of Finasteride use due to loss of androgens (DHT). Note studies at bottom in particular. Meibomian glands and ocular surfaces in teh eye express AR and 5AR enzymes, both get negatively affected when you use finasteride due to inhibition of 5AR2/DHT.
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Propecia-associated bilateral cataract
Clinical & Experimental Ophthalmology Volume 32 Issue 1 Page 106-108, February 2004
A 43-year-old man presented suffering from decreasing vision in both eyes for 3 months. The patient's visual acuity was 6/20 (non-corrected) in the right eye and 6/10 (?1.75/?1.00 × 91) in the left. Ocular examination of both eyes revealed anterior subcapsular opacities of both lenses with the right eye being more severe than the left. He had been taking finasteride (Propecia; Merck, Sharp and Dohme) at 1 mg/day for 3 years to treat early stage of androgenic alopecia.
It was highly suspected that finasteride was associated with the anterior subcapsular opacity on the lens, and the patient therefore discontinued use of finasteride. He underwent uneventful cataract extraction surgery and intraocular lens implantation of the right eye.
One month after cataract surgery in the right eye, the best-corrected visual acuity was right 6/6 (?1.25) and left 6/10 (?2.00/?0.50 × 100). To the best of the authors’ knowledge, this is the first reported case of Propecia-associated cataract.
Intraoperative floppy-iris syndrome and finasteride intake
Department of Ophthalmology, James Cook University Hospital, Middlesbrough, Cleveland, United Kingdom
We report 2 male patients who had bilateral cataract surgery. Both patients had features of the intraoperative floppy-iris syndrome (IFIS) in both eyes, and both were taking oral finasteride for the management of benign prostatic hyperplasia (BPH).
We conclude that finasteride can be associated with IFIS, so it is important to take detailed medical histories of patients having cataract surgery, paying attention to a history of BPH and its treatment.
Finasteride: First report of central serous chorioretinopathy: case report. Source: Reactions, Volume 1, Number 1223, 2008-10-11 , pp. 14-14(1)
Publisher: Adis International
Effect of Androgen Deficiency on the Human Meibomian Gland and Ocular Surface
Journal of Clinical Endocrinology & Metabolism Vol. 85, No. 12 4874-4882
"... The rationale for this comparison was that finasteride, but not the other antiandrogen compounds, might act to inhibit the local conversion of testosterone to DHT (24). If so, finasteride actions might reflect the importance of local steroidogenesis per se in providing potent androgens to ocular surface tissues."
These comparisons showed that the left and right eyes of patients taking finasteride had a significantly higher frequency of appearance of conjunctival bulbar injection (finasteride group, 100%; other treatment group, 50%; P < 0.05), lid collarettes (finasteride group, 66.7%; other treatment group, 15%; P < 0.05), metaplasia of meibomian gland orifices (finasteride group, 100%; other treatment group, 54.6%; P < 0.01), and corneal fluorescein staining (finasteride group, 87.5%; other treatment group, 31.8%; P < 0.01). Finasteride-treated patients also had a significantly greater sensitivity to wind (finasteride group, 75% positive responses; other treatment group, 0% positive responses; P < 0.005)."
"... Consequently, given that this tissue is an androgen target organ (26), contains both androgen receptor protein and 5-reductase mRNA (9), and responds to androgens with an enhanced lipid synthesis, production and release (11, 12), it would seem that antiandrogen therapy and the resulting androgen deficiency would lead to meibomian gland dysfunction.
"... Another consideration in the response of the conjunctiva and cornea to antiandrogen therapy is that these tissues express Types 1 and 2 5-reductase mRNA and/or androgen receptor mRNA and protein. Furthermore, androgens have been shown to influence the functional activity of both the conjunctiva and cornea."
"... Thus, finasteride administration, compared with the analogs of LH-releasing hormone or the nonsteroidal antiandrogens, seemed to be associated with a greater frequency of conjunctival bulbar injection, lid collarettes, metaplasia of meibomian gland orifices, corneal fluorescein staining, and wind sensitivity.
"... Our results demonstrate that patients taking antiandrogen treatment, compared with age-related controls, had a:
1) significant increase in the frequency of appearance of tear film debris, an abnormal tear film meniscus, irregular posterior lid margins, conjunctival tarsal injection, and orifice metaplasia of the meibomian glands;
2) significant increase in the degree of ocular surface vital dye staining;
3) significant decrease in the tear film breakup time and quality of meibomian gland secretions; and
4) significant increase in the frequency of light sensitivity, painful eyes, and blurred vision.
In addition, the use of antiandrogen pharmaceuticals was associated with significant changes in the relative amounts of lipids in meibomian gland secretions. Our findings indicate that chronic androgen deficiency is associated with meibomian gland dysfunction and dry eye.
Impact of Antiandrogen Treatment on the Fatty Acid Profile of Neutral Lipids in Human Meibomian Gland Secretions
The Journal of Clinical Endocrinology & Metabolism Vol. 85, No. 12 4866-4873
.."In support of these hypotheses, we and others have discovered that meibomian glands contain androgen receptor messenger RNA (mRNA) and protein within acinar epithelial cells (2, 3), express mRNAs for both Types 1 and 2 5-reductase (3), and respond to an androgen precursor with an increased production and release of lipids"
"... In addition, we have observed that androgen deficiency seems to be associated with meibomian gland dysfunction and an increase in the signs and symptoms of dry eye.2
Thus, our data suggest that patients taking antiandrogen therapy, compared with controls, have:
1) significant changes in their meibomian glands, including orifice metaplasia, a poorer quality of secretions, and a morphology consistent with severe disease;
2) a significant alteration in the overall neutral lipid pattern of their meibomian gland secretions, including an attenuation in the amounts of cholesterol esters, wax esters, diglycerides, and triglycerides, relative to those of cholesterol;
3) tear film instability; and
4) a higher frequency of ocular surface symptoms (i.e. light sensitivity, painful eyes, blurred vision)."
"... Male subjects receiving antiandrogen treatment for prostatic indications were recruited from the Departments of Urology at the Brigham and Women’s Hospital and Boston University Medical Center (Boston, MA). These patients (n = 15), whose average age was 70.9 ± 1.9 yr, had been treated with antiandrogen medications (i.e. leuprolide acetate, goserelin acetate, bicalutamide, flutamide, and/or finasteride) for intervals ranging from 3–96 months (median, 36 months). Age-related male controls (64.8 ± 1.0 yr old; n = 6), who were not receiving antiandrogen therapy, were recruited from the Boston area."
"... The effect of antiandrogen treatment on the lipid profile of meibomian gland secretions may contribute to the tear film instability and dry eye symptoms observed in patients taking these medications (see Footnote 1).
Tear film stability, as well as the maintenance of ocular surface integrity and the preservation of visual acuity, are critically dependent on the release of an optimal mixture of lipids by the meibomian gland (6, 7, 8, 19).
A significant alteration in the quality of these lipids, such as induced by antiandrogen therapy, may promote tear film evaporation and consequent dry eye.
If so, this finding may help to explain the etiology of the evaporative dry eye observed in other androgen-deficient states (20, 21, 22, 23), such as menopause, aging, Sjögren’s syndrome, and complete androgen insensitivity syndrome "