Ocular Toxicity & Systemic Medication

A Friendly Reminder...

Ocular toxicity due to systemic medication can present a significant challenge in daily practice, requiring appropriate management and interdisciplinary collaboration. We should be reminded to fully understand the pharmacology of each and every medication our patients are prescribed, and be aware of potential adverse ocular effects.

Commonly implicated agents include hydroxychloroquine and associated maculopathy; ethambutol, known for its potential to induce optic neuropathy; and tamoxifen, which may lead to crystalline retinopathy. Additionally, certain anticonvulsants and psychotropic medications have been linked to pigmentary retinopathy and angle-closure glaucoma. Of course there are many other examples. The manifestation of toxicity can range from subtle ocular findings to severe pathology and irreversible vision loss. Therefore, it is always important to maintain a high index of suspicion, particularly in individuals with complex medical histories or those on long-term medical therapy.

Comprehensive but targeted exams in terms of "pharmacologic awareness", sometimes with advanced imaging techniques, are key for early detection and management of drug-induced ocular complications.

-JRM