DRUG - RELATED RETINOPATHIES

1. Antimalarials• Chloroquine• Hydroxychloroquine

2. Phenothiazines

3. Crystalline maculopathies• Tamoxifen• Canthaxanthin

• Chlopromazine• Thioridazine

Antimalarials

Hydroxychloroquine - very small risk of toxicity

Chloroquine - risk of toxicity with cumulative dose of 300 g

VA - 6/18 to 6/24

Early bull’s eyemaculopathy

VA - CF

End-stage

VA - 6/36 to 6/60

Advanced bull’s eye maculopathy

FA of bull’s eye maculopathy

Increased background choroidal fluorescence due to RPE window defect

PhenothiazinesChlorpromazine - very small risk of toxicity

• Coarse, plaque-like pigmentation

Thioridazine - risk of toxicity if daily dose exceeds 800 mg

• Focal loss of RPE and choriocapillaris

• Diffuse loss of RPE and choriocapillaris

Crystalline maculopathies

Tamoxifen

• Crystalline, ring-like macular deposits

Canthaxanthin

• Only with very high doses

• May cause visual impairment

• Glistening dots arranged in doughnut shape at posterior poles

• Visually innocuous

• If used over prolonged periods of time

Crystalline maculopathies

Tamoxifen

• Crystalline, ring-like macular deposits

Canthaxanthin

• Only with very high doses

• May cause visual impairment

• Glistening dots arranged in doughnut shape at posterior poles

• Visually innocuous

• If used over prolonged periods of time