Published: 3 September 2026

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Ocular adverse effects of stimulant medicines for ADHD

Published: 3 September 2026
Prescriber Update 47(3): 48–49
September 2026

The stimulant medicines used to treat attention deficit hyperactivity disorder (ADHD) are methylphenidate, lisdexamfetamine and dexamfetamine.^1–4 This article highlights the ocular adverse effects associated with these medicines.

Ocular adverse effects

Increased intraocular pressure (IOP), glaucoma, dry eye and other ocular adverse effects have been reported with use of stimulant medicines for ADHD. ^1–4

Glaucoma refers to a group of eye conditions characterised by progressive optic nerve damage, usually associated with increased IOP and is one of the leading causes of irreversible blindness.⁵ There have been international reports of increased IOP and glaucoma with methylphenidate treatment.^1,2

Acute angle-closure (AAC) glaucoma has also been reported with methylphenidate.¹ AAC glaucoma results from a rapid increase in IOP due to an obstruction blocking the regular outflow of vitreous humour from the eye.⁶ It is a medical emergency and presents as a sudden onset of severe unilateral eye pain or a headache associated with blurred vision, rainbow-colored halos around bright lights, nausea and vomiting.⁶ Patients with significant hyperopia (farsightedness) are at risk of AAC glaucoma.^1,2

Dry eye has been reported with methylphenidate and lisdexamfetamine.^2,3 Symptoms of dry eye may include ocular irritation, foreign body sensation, redness, blurred vision and discomfort.⁷

Other ocular adverse reactions reported with methylphenidate, lisdexamfetamine and dexamfetamine include diplopia (double vision), difficulties with accommodation, blurred vision and mydriasis (excessively dilated pupils).^1–4

Refer to the recommendations provided in the relevant data sheets for patients with a history of increased IOP or glaucoma, or those at risk for acute angle-closure glaucoma.

• Search for a data sheet

Advise patients to promptly report visual disturbances or other changes in vision.⁸

New Zealand case reports

Between 1 January 2010 and 31 May 2026, the New Zealand Pharmacovigilance Database received 5 case reports of eye-related disorders with stimulant medicines.

• Blurred vision (111822, 114103, NZ-Medsafe-158750) and mydriasis (NZ-Medsafe-155052) were reported with methylphenidate.
• Blurred vision (149093) was reported with dexamfetamine.

References

1. Novartis New Zealand Limited. 2026. Ritalin and Ritalin LA New Zealand Data Sheet 29 January 2026. URL: www.medsafe.govt.nz/profs/Datasheet/r/RitalintabSRtabLAtab.pdf (accessed 20 July 2026).
2. Janssen-Cilag (New Zealand) Ltd. 2026. Concerta Tablet New Zealand Data Sheet 27 January 2026. URL: www.medsafe.govt.nz/profs/Datasheet/c/Concertatab.pdf (accessed 20 July 2026).
3. Takeda New Zealand Limited. 2026. Vyvanse Capsule New Zealand Data Sheet 4 June 2026. URL: www.medsafe.govt.nz/profs/Datasheet/v/vyvansecap.pdf (accessed 20 July 2026).
4. Pharmacy Retailing (NZ) Limited. 2026. Aspen Dexamfetamine Tablet New Zealand Data Sheet 16 March 2026. URL: www.medsafe.govt.nz/profs/datasheet/a/AspenDexamfetaminetab.pdf (accessed 27 July 2026).
5. Jannini TB, Alisi L, Giovannetti F, et al. 2026. The effect of psychotropic medications on glaucoma risk and intraocular pressure: A Bayesian meta-analysis. CNS Drugs 40(3): 451–466. DOI: 10.1007/s40263-025-01249-6 (accessed 20 July 2026).
6. Khazaeni B, Zeppieri M, Khazaeni L. 2026. Acute angle-closure glaucoma. In: StatPearls [Internet] updated 10 January 2026. URL: www.ncbi.nlm.nih.gov/books/NBK430857/ (accessed 6 August 2026).
7. Health New Zealand Te Whatu Ora. 2026. Dry eyes 22 July 2026. URL: www.healthnz.govt.nz/health-topics/conditions-treatments/eyes/dry-eyes#symptoms-of-dry-eyes-6009 (accessed 27 July 2026).
8. Takeda New Zealand Limited. 2026. Vyvanse Capsules New Zealand Consumer Medicine Information June 2026. URL: www.medsafe.govt.nz/consumers/CMI/v/vyvanse.pdf (accessed 20 July 2026).