Retinal Manifestations of Drug Toxicity

H Richard McDonald, MD

[Editor’s note: Patients with diabetes may take dietary supplements or be subjected to medical procedures using pharmacologic agents that place them at additional risk of retinopathy. Dr McDonald, editor of the monthly feature “Diagnostic and Therapeutic Challenges” in the journal Retina, listed drugs that can cause retinal damage in this presentation.]

• Aminoglycosides—an antibiotic class that causes irreversible retinal damage if inadvertently administered by intraocular injection. Aminoglycosides should NEVER be used for endophthalmitis prophylaxis following ocular surgery!
• Canthaxathine—an over-the-counter oral tanning agent; can cause crystalline retinopathy.
• Cisplatin—a class of cancer treatments that causes severe retinopathy if inadvertently administered by intraocular injection.
• Deferoxamine—an iron chelator
• Ethylene glycol—an ingredient in automotive antifreeze; deposits calcium oxalate crystals along the arterioles
• Interferon—an immunomodulator often used to treat viral hepatitis that causes severe retinopathy if inadvertently administered by intraocular injection.
• Methoxyfluorane—a general anesthetic; deposits calcium oxalate crystals along the arterioles
• Niacin—causes retinopathy at doses of 1.5 g/day or greater, but retinal effects can occur at lower doses.
• Nutritional supplements containing homocysteine, or substances that metabolize to homocysteine (eg, SAM-e).
• Phenothiazines—a class of antipsychotics; risk of retinopathy depends on total daily dose
• Quinine—an old malaria treatment sometimes used to treat leg cramps; directly toxic to photoreceptors and ganglion cells, but retina usually recovers after treatment is discontinued.
• Quinolones—an antibiotic class; toxic to retinal pigment epithelium.
• Talc injection—may occur with Ritalin or methadone abuse.