Toxic Retinopathies

Common toxic retinopathies:

  • Antimalarials – chloroquine / hydroxycholoroquine

  • Phenthiazines

  • Tamoxifen

  • Talc


Antimalarials:

  • Maculopathy – once ‘bull’s eye retinopathy’ develops, it is irreversible.

  • Management: Refer to RCOphth guidelines 2020.

  • Quinine toxicity –> retinal oedema, fixed dilated pupils, attenuated arterioles, constricted visual fields & optic nerve atrophy.

Phenothiazine:

  • Medication for schizophrenia.

  • Thioridazine (normal dose: 150-600mg/day) – >800mg/day few wks –> toxicity.

  • Chlorpromazine (Largactil) (normal dose: 75-300mg/day) – >2400mg/day few wks –> toxicity

  • Beginning – pigmentary changes – “salt and pepper” appearance –> geographic atrophy (late stages)


Tamoxifen:

  • Anti oestrogen treatment for breast carcinoma.

  • Usual dose is 20-40mg/day.

  • Vortex keratopathy and optic neuritis – rare and reversible.

  • Crystalline retinopathy.

Talc maculopathy:

  • Extent corresponds with amount and duration of drug abuse (cocaine or methylphenidate/Ritalin).

  • Multiple tiny yellow-white glistening particles over posterior pole.

  • Can lead to macular oedema, flame-shaped haemorrhages and arterial occlusion with talc emboli.

  • Microtalc retinopathy – NFL defect like glaucoma.

  • Refer to respiratory physician as ocular talc indicates lung function may be compromised.

 
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