Drug Induced Retinal Choroidal Disorders Flashcards
Chloroquine/ Hydroxychloroquine Retinotoxicity
degeneration of RPE using quinolones
affects melanin containing structures- RPE and choroid
Symptoms of Chloroquine/ Hydroxychloroquine Retinotoxicity
initial paracentral scotoma and color vision defects
VAs later become markedly reduced as macula becomes affected
Signs of Chloroquine/ Hydroxychloroquine Retinotoxicity
loss of FLR
parafoveal RPE stippling
progresses to ring of parafoveal RPE atrophy- bulls eye maculopathy
choroid shows as RPE atrophies
Mx of Chloroquine/ Hydroxychloroquine Retinotoxicity
discontinue meds
communicate with physician
Risk Factors for Plaquenil Retinotoxicity
on meds for 5+ years
>1000g dose
elderly, lever/ kidney dysfunction
prior retinal disease
Monitoring for Plaquenil Retinotoxicity
baseline exam before prescribing- central 10 degree VF and OCT, FAF, mf ERG
yearly review
Phenothiazine Retinopathy
visual loss and pigmentary retinopathy from high doses (>800mg) of phenothiazines
meds accumulate in RPE- damage
Drugs causing Phenothiazine Retinopathy
Thioridazine (Melleril)
Chlopromazine (Largactil)
for psychiatric disorders
Symptoms of Phenothiazine Retinopathy
sudden onset of visual disturbances- nyctalopia (poor vision in dim light) and dyschromatopsia (red/ brown)
Signs of Phenothiazine Retinopathy
granular RPE changes
focal RPE loss and clumping
Mx of Phenothiazine Retinopathy
discontinue meds
Meds causing Crystalline Maculopathies
Tamoxifen
Canthaxanthin
Methoxyflurane
Nitrofurantoin
Tamoxifen
causes Crystalline Maculopathy
for breast cancer
foveal cysts that resolve upon discontinuation
Canthaxanthin
causes Crystalline Maculopathy
sun tan simulation
ring of crystals, asymptomatic
Methoxyflurane
causes Crystalline Maculopathy
inhaled anesthetic
permanent RPE hyperplasia
