Chlorpromazine (Thorazine)? Thioridazine (Mellaril) Tamoxifen

1 Q Systemic drugs and ocular toxicity: Matching

 Chlorpromazine (Thorazine)?  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop  Cidofovir  Causes a crystalline retinopathy  Isotretinoin (Accutane)  Causes nyctalopia  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon

(Start with chlorpromazine and work down the list) 2 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop  Cidofovir  Causes a crystalline retinopathy  Isotretinoin (Accutane)  Causes nyctalopia  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 3

Systemic drugs and ocular toxicity: Matching

Chlorpromazine: Blair Witch cataract 4 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  ThioridazineWhat class of medicine (isMellaril chlorpromazine?) It is a phenothiazine doses <800 mg/d   TamoxifenWhat sort of med are phenothiazines? Blair Witch cataract They are neuroleptics (but have other uses as well)  Iritis, hypotony can  Sildenafil (Viagra) In addition to cataracts, what ophthalmic effects does develop high-dose chlorpromazine therapy have?  CidofovirIt causes pigmentation of the lids and conj  Causes a crystalline retinopathy  IsotretinoinWhat corneal finding (Accutane)is associated with high-dose phenothiazine use?  Causes nyctalopia Corneal verticillata  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 5 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  ThioridazineWhat class of medicine (isMellaril chlorpromazine?) It is a phenothiazine doses <800 mg/d   TamoxifenWhat sort of med are phenothiazines? Blair Witch cataract They are neuroleptics (but have other uses as well)  Iritis, hypotony can  Sildenafil (Viagra) In addition to cataracts, what ophthalmic effects does develop high-dose chlorpromazine therapy have?  CidofovirIt causes pigmentation of the lids and conj  Causes a crystalline retinopathy  IsotretinoinWhat corneal finding (Accutane)is associated with high-dose phenothiazine use?  Causes nyctalopia Corneal verticillata  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 6 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  ThioridazineWhat class of medicine (isMellaril chlorpromazine?) It is a phenothiazine doses <800 mg/d   TamoxifenWhat sort of med are phenothiazines? Blair Witch cataract They are neuroleptics (but have other uses as well)  Iritis, hypotony can  Sildenafil (Viagra) In addition to cataracts, what ophthalmic effects does develop high-dose chlorpromazine therapy have?  CidofovirIt causes pigmentation of the lids and conj  Causes a crystalline retinopathy  IsotretinoinWhat corneal finding (Accutane)is associated with high-dose phenothiazine use?  Causes nyctalopia Corneal verticillata  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 7 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  ThioridazineWhat class of medicine (isMellaril chlorpromazine?) It is a phenothiazine doses <800 mg/d   TamoxifenWhat sort of med are phenothiazines? Blair Witch cataract They are neuroleptics  Iritis, hypotony can  Sildenafil (Viagra) In addition to cataracts, what ophthalmic effects does develop high-dose chlorpromazine therapy have?  CidofovirIt causes pigmentation of the lids and conj  Causes a crystalline retinopathy  IsotretinoinWhat corneal finding (Accutane)is associated with high-dose phenothiazine use?  Causes nyctalopia Corneal verticillata  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 8 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  ThioridazineWhat class of medicine (isMellaril chlorpromazine?) It is a phenothiazine doses <800 mg/d   TamoxifenWhat sort of med are phenothiazines? Blair Witch cataract They are neuroleptics  Iritis, hypotony can  Sildenafil (Viagra) WhatIn sortaddition of drug to cataracts,are neuroleptics? what ophthalmic effects does develop Theyhigh are- doseantipsychotics chlorpromazine--so-called therapy ‘major have? tranquilizers’  CidofovirIt causes pigmentation of the lids and conj  Causes a crystalline retinopathy  IsotretinoinWhat corneal finding (Accutane)is associated with high-dose phenothiazine use?  Causes nyctalopia Corneal verticillata  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 9 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  ThioridazineWhat class of medicine (isMellaril chlorpromazine?) It is a phenothiazine doses <800 mg/d   TamoxifenWhat sort of med are phenothiazines? Blair Witch cataract They are neuroleptics  Iritis, hypotony can  Sildenafil (Viagra) WhatIn sortaddition of drug to cataracts,are neuroleptics? what ophthalmic effects does develop Theyhigh are- doseantipsychotics chlorpromazine--so-called therapy ‘major have? tranquilizers’  CidofovirIt causes pigmentation of the lids and conj  Causes a crystalline retinopathy  IsotretinoinWhat corneal finding (Accutane)is associated with high-dose phenothiazine use?  Causes nyctalopia Corneal verticillata  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 10 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  ThioridazineWhat class of medicine (isMellaril chlorpromazine?) It is a phenothiazine doses <800 mg/d   TamoxifenWhat sort of med are phenothiazines? Blair Witch cataract They are neuroleptics  Iritis, hypotony can  Sildenafil (Viagra) In addition to cataracts, what ophthalmic effects does develop high-dose chlorpromazine therapy have?  CidofovirIt causes pigmentation of the lids and conj  Causes a crystalline retinopathy  IsotretinoinWhat corneal finding (Accutane)is associated with high-dose phenothiazine use?  Causes nyctalopia Corneal verticillata  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 11 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  ThioridazineWhat class of medicine (isMellaril chlorpromazine?) It is a phenothiazine doses <800 mg/d   TamoxifenWhat sort of med are phenothiazines? Blair Witch cataract They are neuroleptics  Iritis, hypotony can  Sildenafil (Viagra) In addition to cataracts, what ophthalmic effects does develop high-dose chlorpromazine therapy have?  CidofovirIt causes pigmentation of the lids and conj  Causes a crystalline retinopathy  IsotretinoinWhat corneal finding (Accutane)is associated with high-dose phenothiazine use?  Causes nyctalopia Corneal verticillata  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 12

Systemic drugs and ocular toxicity: Matching

Chloropromazine-associated pigmentation 13 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  ThioridazineWhat class of medicine (isMellaril chlorpromazine?) It is a phenothiazine doses <800 mg/d   TamoxifenWhat sort of med are phenothiazines? Blair Witch cataract They are neuroleptics  Iritis, hypotony can  Sildenafil (Viagra) In addition to cataracts, what ophthalmic effects does develop high-dose chlorpromazine therapy have?   CidofovirIt causes pigmentation of the lids and conj Causes a crystalline retinopathy  IsotretinoinWhatDoes corneal it cause finding a pigmentary(Accutane)is associated retinopathy with high- doseas well? phenothiazineVery rarely use?  Causes nyctalopia Corneal verticillata  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 14 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  ThioridazineWhat class of medicine (isMellaril chlorpromazine?) It is a phenothiazine doses <800 mg/d   TamoxifenWhat sort of med are phenothiazines? Blair Witch cataract They are neuroleptics  Iritis, hypotony can  Sildenafil (Viagra) In addition to cataracts, what ophthalmic effects does develop high-dose chlorpromazine therapy have?   CidofovirIt causes pigmentation of the lids and conj Causes a crystalline retinopathy  IsotretinoinWhatDoes corneal it cause finding a pigmentary(Accutane)is associated retinopathy with high- doseas well? phenothiazineVery rarely use?  Causes nyctalopia Corneal verticillata  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 15 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  ThioridazineWhat class of medicine (isMellaril chlorpromazine?) It is a phenothiazine doses <800 mg/d   TamoxifenWhat sort of med are phenothiazines? Blair Witch cataract They are neuroleptics  Iritis, hypotony can  Sildenafil (Viagra) In addition to cataracts, what ophthalmic effects does develop high-dose chlorpromazine therapy have?  CidofovirIt causes pigmentation of the lids and conj  Causes a crystalline retinopathy  IsotretinoinWhat corneal finding (Accutane)is associated with high-dose phenothiazine use?  Causes nyctalopia Corneal verticillata  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 16 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  ThioridazineWhat class of medicine (isMellaril chlorpromazine?) It is a phenothiazine doses <800 mg/d   TamoxifenWhat sort of med are phenothiazines? Blair Witch cataract They are neuroleptics  Iritis, hypotony can  Sildenafil (Viagra) In addition to cataracts, what ophthalmic effects does develop high-dose chlorpromazine therapy have?  CidofovirIt causes pigmentation of the lids and conj  Causes a crystalline retinopathy  IsotretinoinWhat corneal finding (Accutane)is associated with high-dose phenothiazine use?  Causes nyctalopia Corneal verticillata  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 17 Q Systemic drugs and retinalocular toxicity: Matching

Systemic drugs and ocular toxicity: Matching

Cornea verticillata 20 Q Systemic drugs and retinalocular toxicity: Matching

Systemic drugs and ocular toxicity: Matching

Cornea verticillata in Fabry’s dz 43 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  ThioridazineWhat class of medicine (isMellaril chlorpromazine?) It is a phenothiazine doses <800 mg/d What are corneal verticillata? Whorl-shaped pigmented deposits found in the  TamoxifenWhat sort of med are phenothiazines? Blair Witch cataract inferior interpalpebral zone of the cornea They are neuroleptics  Iritis, hypotony can  Sildenafil (Viagra)By what other name is this condition known? OtherIn addition than cataracts, to cataracts, what whatclinically ophthalmic significant effects ophthalmic does occurrence can be ‘Vortex keratopathy’ develop inducedhigh-dose by chlorpromazine? chlorpromazine therapy have? OculogyricIt causes crisis pigmentation of the lids and conj  Causes a crystalline Cidofovir Are they visually significant? What class of metabolic disorder is Fabry’s? What is an ‘oculogyric crisisOnly’? rarely retinopathy  What corneal finding is associated with highA-dose lysosomal -storage disorder AnIsotretinoinphenothiazine idiosyncratic drug use? reaction(Accutane) consisting of tonic upward deviation of the eyes Do verticillate resolve with cessation of theCauses drug? nyctalopia Corneal verticillata Which enzyme is deficient in Fabry’s? Yes WhichRifabutin class of drugs is most commonly implicated?Galactosidase A  Yellow tinting of The neuroleptics, duh Name three other meds,What otherand one signs/symptoms metabolicvision dz are, characteristic of Fabry’s…  associated with corneal verticillata: WhatDigitalis other class of med is classic for inducingIn oculogyric childhood: crisis? The antiemetics --Fabry’s dz --Severe extremity painCauses uveitis with --Amiodarone --Angiokeratomas hypopyon What medicine can be used-- toIndomethacin break the crisis? Anticholinergics In early adulthood: --Thorazine --Cardiovascular problems --Hydroxychloroquine--Renal failure --Seizures 44 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  ThioridazineWhat class of medicine (isMellaril chlorpromazine?) It is a phenothiazine doses <800 mg/d What are corneal verticillata? Whorl-shaped pigmented deposits found in the  TamoxifenWhat sort of med are phenothiazines? Blair Witch cataract inferior interpalpebral zone of the cornea They are neuroleptics  Iritis, hypotony can  Sildenafil (Viagra)By what other name is this condition known? OtherIn addition than cataracts, to cataracts, what whatclinically ophthalmic significant effects ophthalmic does occurrence can be ‘Vortex keratopathy’ develop inducedhigh-dose by chlorpromazine? chlorpromazine therapy have? OculogyricIt causes crisis pigmentation of the lids and conj  Causes a crystalline Cidofovir Are they visually significant? What class of metabolic disorder is Fabry’s? What is an ‘oculogyric crisisOnly’? rarely retinopathy  What corneal finding is associated with highA-dose lysosomal -storage disorder AnIsotretinoinphenothiazine idiosyncratic drug use? reaction(Accutane) consisting of tonic upward deviation of the eyes Do verticillate resolve with cessation of theCauses drug? nyctalopia Corneal verticillata Which enzyme is deficient in Fabry’s? Yes WhichRifabutin class of drugs is most commonly implicated?Galactosidase A  Yellow tinting of The neuroleptics, duh Name three other meds,What otherand one signs/symptoms metabolicvision dz are, characteristic of Fabry’s…  associated with corneal verticillata: WhatDigitalis other class of med is classic for inducingIn oculogyric childhood: crisis? The antiemetics --Fabry’s dz --Severe extremity painCauses uveitis with --Amiodarone --Angiokeratomas hypopyon What medicine can be used-- toIndomethacin break the crisis? Anticholinergics In early adulthood: --Thorazine --Cardiovascular problems --Hydroxychloroquine--Renal failure --Seizures 45 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  ThioridazineWhat class of medicine (isMellaril chlorpromazine?) It is a phenothiazine doses <800 mg/d What are corneal verticillata? Whorl-shaped pigmented deposits found in the  TamoxifenWhat sort of med are phenothiazines? Blair Witch cataract inferior interpalpebral zone of the cornea They are neuroleptics  Iritis, hypotony can  Sildenafil (Viagra)By what other name is this condition known? OtherIn addition than cataracts, to cataracts, what whatclinically ophthalmic significant effects ophthalmic does occurrence can be ‘Vortex keratopathy’ develop inducedhigh-dose by chlorpromazine? chlorpromazine therapy have? OculogyricIt causes crisis pigmentation of the lids and conj  Causes a crystalline Cidofovir Are they visually significant? What class of metabolic disorder is Fabry’s? What is an ‘oculogyric crisisOnly’? rarely retinopathy  What corneal finding is associated with highA-dose lysosomal -storage disorder AnIsotretinoinphenothiazine idiosyncratic drug use? reaction(Accutane) consisting of tonic upward deviation of the eyes Do verticillate resolve with cessation of theCauses drug? nyctalopia Corneal verticillata Which enzyme is deficient in Fabry’s? Yes WhichRifabutin class of drugs is most commonly implicated?Galactosidase A  Yellow tinting of The neuroleptics, duh Name three other meds,What otherand one signs/symptoms metabolicvision dz are, characteristic of Fabry’s…  associated with corneal verticillata: WhatDigitalis other class of med is classic for inducingIn oculogyric childhood: crisis? The antiemetics --Fabry’s dz --Severe extremity painCauses uveitis with --Amiodarone --Angiokeratomas hypopyon What medicine can be used-- toIndomethacin break the crisis? Anticholinergics In early adulthood: --Thorazine --Cardiovascular problems --Hydroxychloroquine--Renal failure --Seizures 46 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  ThioridazineWhat class of medicine (isMellaril chlorpromazine?) It is a phenothiazine doses <800 mg/d What are corneal verticillata? Whorl-shaped pigmented deposits found in the  TamoxifenWhat sort of med are phenothiazines? Blair Witch cataract inferior interpalpebral zone of the cornea They are neuroleptics  Iritis, hypotony can  Sildenafil (Viagra)By what other name is this condition known? OtherIn addition than cataracts, to cataracts, what whatclinically ophthalmic significant effects ophthalmic does occurrence can be ‘Vortex keratopathy’ develop inducedhigh-dose by chlorpromazine? chlorpromazine therapy have? OculogyricIt causes crisis pigmentation of the lids and conj  Causes a crystalline Cidofovir Are they visually significant? What class of metabolic disorder is Fabry’s? What is an ‘oculogyric crisisOnly’? rarely retinopathy  What corneal finding is associated with highA-dose lysosomal -storage disorder AnIsotretinoinphenothiazine idiosyncratic drug use? reaction(Accutane) consisting of tonic upward deviation of the eyes Do verticillate resolve with cessation of theCauses drug? nyctalopia Corneal verticillata Which enzyme is deficient in Fabry’s? Yes WhichRifabutin class of drugs is most commonly implicated?Galactosidase A  Yellow tinting of The neuroleptics, duh Name three other meds,What otherand one signs/symptoms metabolicvision dz are, characteristic of Fabry’s…  associated with corneal verticillata: WhatDigitalis other class of med is classic for inducingIn oculogyric childhood: crisis? The antiemetics --Fabry’s dz --Severe extremity painCauses uveitis with --Amiodarone --Angiokeratomas hypopyon What medicine can be used-- toIndomethacin break the crisis? Anticholinergics In early adulthood: --Thorazine --Cardiovascular problems --Hydroxychloroquine--Renal failure --Seizures 47 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  ThioridazineWhat class of medicine (isMellaril chlorpromazine?) It is a phenothiazine doses <800 mg/d What are corneal verticillata? Whorl-shaped pigmented deposits found in the  TamoxifenWhat sort of med are phenothiazines? Blair Witch cataract inferior interpalpebral zone of the cornea They are neuroleptics  Iritis, hypotony can  Sildenafil (Viagra)By what other name is this condition known? OtherIn addition than cataracts, to cataracts, what whatclinically ophthalmic significant effects ophthalmic does occurrence can be ‘Vortex keratopathy’ develop inducedhigh-dose by chlorpromazine? chlorpromazine therapy have? OculogyricIt causes crisis pigmentation of the lids and conj  Causes a crystalline Cidofovir Are they visually significant? What class of metabolic disorder is Fabry’s? What is an ‘oculogyric crisisOnly’? rarely retinopathy  What corneal finding is associated with highA-dose lysosomal -storage disorder AnIsotretinoinphenothiazine idiosyncratic drug use? reaction(Accutane) consisting of tonic upward deviation of the eyes Do verticillate resolve with cessation of theCauses drug? nyctalopia Corneal verticillata Which enzyme is deficient in Fabry’s? Yes WhichRifabutin class of drugs is most commonly implicated?Galactosidase A  Yellow tinting of The neuroleptics, duh Name three other meds,What otherand one signs/symptoms metabolicvision dz are, characteristic of Fabry’s…  associated with corneal verticillata: WhatDigitalis other class of med is classic for inducingIn oculogyric childhood: crisis? The antiemetics --Fabry’s dz --Severe extremity painCauses uveitis with --Amiodarone --Angiokeratomas hypopyon What medicine can be used-- toIndomethacin break the crisis? Anticholinergics In early adulthood: --Thorazine --Cardiovascular problems --Hydroxychloroquine--Renal failure --Seizures 48 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  ThioridazineWhat class of medicine (isMellaril chlorpromazine?) It is a phenothiazine doses <800 mg/d What are corneal verticillata? Whorl-shaped pigmented deposits found in the  TamoxifenWhat sort of med are phenothiazines? Blair Witch cataract inferior interpalpebral zone of the cornea They are neuroleptics  Iritis, hypotony can  Sildenafil (Viagra)By what other name is this condition known? OtherIn addition than cataracts, to cataracts, what whatclinically ophthalmic significant effects ophthalmic does occurrence can be ‘Vortex keratopathy’ develop inducedhigh-dose by chlorpromazine? chlorpromazine therapy have? OculogyricIt causes crisis pigmentation of the lids and conj  Causes a crystalline Cidofovir Are they visually significant? What class of metabolic disorder is Fabry’s? What is an ‘oculogyric crisisOnly’? rarely retinopathy  What corneal finding is associated with highA-dose lysosomal -storage disorder AnIsotretinoinphenothiazine idiosyncratic drug use? reaction(Accutane) consisting of tonic upward deviation of the eyes Do verticillate resolve with cessation of theCauses drug? nyctalopia Corneal verticillata Which enzyme is deficient in Fabry’s? Yes WhichRifabutin class of drugs is most commonly implicated?Galactosidase A  Yellow tinting of The neuroleptics, duh Name three other meds,What otherand one signs/symptoms metabolicvision dz are, characteristic of Fabry’s…  associated with corneal verticillata: WhatDigitalis other class of med is classic for inducingIn oculogyric childhood: crisis? The antiemetics --Fabry’s dz --Severe extremity painCauses uveitis with --Amiodarone --Angiokeratomas hypopyon What medicine can be used-- toIndomethacin break the crisis? Anticholinergics In early adulthood: --Thorazine --Cardiovascular problems --Hydroxychloroquine--Renal failure --Seizures 49 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  ThioridazineWhat class of medicine (isMellaril chlorpromazine?) It is a phenothiazine doses <800 mg/d What are corneal verticillata? Whorl-shaped pigmented deposits found in the  TamoxifenWhat sort of med are phenothiazines? Blair Witch cataract inferior interpalpebral zone of the cornea They are neuroleptics  Iritis, hypotony can  Sildenafil (Viagra)By what other name is this condition known? OtherIn addition than cataracts, to cataracts, what whatclinically ophthalmic significant effects ophthalmic does occurrence can be ‘Vortex keratopathy’ develop inducedhigh-dose by chlorpromazine? chlorpromazine therapy have? OculogyricIt causes crisis pigmentation of the lids and conj  Causes a crystalline Cidofovir Are they visually significant? What class of metabolic disorder is Fabry’s? What is an ‘oculogyric crisisOnly’? rarely retinopathy  What corneal finding is associated with highA-dose lysosomal -storage disorder AnIsotretinoinphenothiazine idiosyncratic drug use? reaction(Accutane) consisting of tonic upward deviation of the eyes Do verticillate resolve with cessation of theCauses drug? nyctalopia Corneal verticillata Which enzyme is deficient in Fabry’s? Yes WhichRifabutin class of drugs Whichis most neuroleptic commonly is implicated? mostGalactosidase commonly implicatedA  Yellow tinting of The neuroleptics, duh(it’s not chlorpromazine)? HaloperidolName three other meds,What otherand one signs/symptoms metabolicvision dz are, characteristic of Fabry’s…  associated with corneal verticillata: WhatDigitalis other class of med is classic for inducingIn oculogyric childhood: crisis? The antiemetics --Fabry’s dz --Severe extremity painCauses uveitis with --Amiodarone --Angiokeratomas hypopyon What medicine can be used-- toIndomethacin break the crisis? Anticholinergics In early adulthood: --Thorazine --Cardiovascular problems --Hydroxychloroquine--Renal failure --Seizures 50 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  ThioridazineWhat class of medicine (isMellaril chlorpromazine?) It is a phenothiazine doses <800 mg/d What are corneal verticillata? Whorl-shaped pigmented deposits found in the  TamoxifenWhat sort of med are phenothiazines? Blair Witch cataract inferior interpalpebral zone of the cornea They are neuroleptics  Iritis, hypotony can  Sildenafil (Viagra)By what other name is this condition known? OtherIn addition than cataracts, to cataracts, what whatclinically ophthalmic significant effects ophthalmic does occurrence can be ‘Vortex keratopathy’ develop inducedhigh-dose by chlorpromazine? chlorpromazine therapy have? OculogyricIt causes crisis pigmentation of the lids and conj  Causes a crystalline Cidofovir Are they visually significant? What class of metabolic disorder is Fabry’s? What is an ‘oculogyric crisisOnly’? rarely retinopathy  What corneal finding is associated with highA-dose lysosomal -storage disorder AnIsotretinoinphenothiazine idiosyncratic drug use? reaction(Accutane) consisting of tonic upward deviation of the eyes Do verticillate resolve with cessation of theCauses drug? nyctalopia Corneal verticillata Which enzyme is deficient in Fabry’s? Yes WhichRifabutin class of drugs Whichis most neuroleptic commonly is implicated? mostGalactosidase commonly implicatedA  Yellow tinting of The neuroleptics, duh(it’s not chlorpromazine)? HaloperidolName three other meds,What otherand one signs/symptoms metabolicvision dz are, characteristic of Fabry’s…  associated with corneal verticillata: WhatDigitalis other class of med is classic for inducingIn oculogyric childhood: crisis? The antiemetics --Fabry’s dz --Severe extremity painCauses uveitis with --Amiodarone --Angiokeratomas hypopyon What medicine can be used-- toIndomethacin break the crisis? Anticholinergics In early adulthood: --Thorazine --Cardiovascular problems --Hydroxychloroquine--Renal failure --Seizures 51 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  ThioridazineWhat class of medicine (isMellaril chlorpromazine?) It is a phenothiazine doses <800 mg/d What are corneal verticillata? Whorl-shaped pigmented deposits found in the  TamoxifenWhat sort of med are phenothiazines? Blair Witch cataract inferior interpalpebral zone of the cornea They are neuroleptics  Iritis, hypotony can  Sildenafil (Viagra)By what other name is this condition known? OtherIn addition than cataracts, to cataracts, what whatclinically ophthalmic significant effects ophthalmic does occurrence can be ‘Vortex keratopathy’ develop inducedhigh-dose by chlorpromazine? chlorpromazine therapy have? OculogyricIt causes crisis pigmentation of the lids and conj  Causes a crystalline Cidofovir Are they visually significant? What class of metabolic disorder is Fabry’s? What is an ‘oculogyric crisisOnly’? rarely retinopathy  What corneal finding is associated with highA-dose lysosomal -storage disorder AnIsotretinoinphenothiazine idiosyncratic drug use? reaction(Accutane) consisting of tonic upward deviation of the eyes Do verticillate resolve with cessation of theCauses drug? nyctalopia Corneal verticillata Which enzyme is deficient in Fabry’s? Yes WhichRifabutin class of drugs is most commonly implicated?Galactosidase A  Yellow tinting of The neuroleptics, duh Name three other meds,What otherand one signs/symptoms metabolicvision dz are, characteristic of Fabry’s…  associated with corneal verticillata: WhatDigitalis other class of med is classic for inducingIn oculogyric childhood: crisis? The antiemetics --Fabry’s dz --Severe extremity painCauses uveitis with --Amiodarone --Angiokeratomas hypopyon What medicine can be used-- toIndomethacin break the crisis? Anticholinergics In early adulthood: --Thorazine --Cardiovascular problems --Hydroxychloroquine--Renal failure --Seizures 52 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  ThioridazineWhat class of medicine (isMellaril chlorpromazine?) It is a phenothiazine doses <800 mg/d What are corneal verticillata? Whorl-shaped pigmented deposits found in the  TamoxifenWhat sort of med are phenothiazines? Blair Witch cataract inferior interpalpebral zone of the cornea They are neuroleptics  Iritis, hypotony can  Sildenafil (Viagra)By what other name is this condition known? OtherIn addition than cataracts, to cataracts, what whatclinically ophthalmic significant effects ophthalmic does occurrence can be ‘Vortex keratopathy’ develop inducedhigh-dose by chlorpromazine? chlorpromazine therapy have? OculogyricIt causes crisis pigmentation of the lids and conj  Causes a crystalline Cidofovir Are they visually significant? What class of metabolic disorder is Fabry’s? What is an ‘oculogyric crisisOnly’? rarely retinopathy  What corneal finding is associated with highA-dose lysosomal -storage disorder AnIsotretinoinphenothiazine idiosyncratic drug use? reaction(Accutane) consisting of tonic upward deviation of the eyes Do verticillate resolve with cessation of theCauses drug? nyctalopia Corneal verticillata Which enzyme is deficient in Fabry’s? Yes WhichRifabutin class of drugs is most commonly implicated?Galactosidase A  Yellow tinting of The neuroleptics, duh Name three other meds,What otherand one signs/symptoms metabolicvision dz are, characteristic of Fabry’s…  associated with corneal verticillata: WhatDigitalis other class of med is classic for inducingIn oculogyric childhood: crisis? The antiemetics --Fabry’s dz --Severe extremity painCauses uveitis with --Amiodarone --Angiokeratomas hypopyon What medicine can be used-- toIndomethacin break the crisis? Anticholinergics In early adulthood: --Thorazine --Cardiovascular problems --Hydroxychloroquine--Renal failure --Seizures 53 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  ThioridazineWhat class of medicine (isMellaril chlorpromazine?) It is a phenothiazine doses <800 mg/d What are corneal verticillata? Whorl-shaped pigmented deposits found in the  TamoxifenWhat sort of med are phenothiazines? Blair Witch cataract inferior interpalpebral zone of the cornea They are neuroleptics  Iritis, hypotony can  Sildenafil (Viagra)By what other name is this condition known? OtherIn addition than cataracts, to cataracts, what whatclinically ophthalmic significant effects ophthalmic does occurrence can be ‘Vortex keratopathy’ develop inducedhigh-dose by chlorpromazine? chlorpromazine therapy have? OculogyricIt causes crisis pigmentation of the lids and conj  Causes a crystalline Cidofovir Are they visually significant? What class of metabolic disorder is Fabry’s? What is an ‘oculogyric crisisOnly’? rarely retinopathy  What corneal finding is associated with highA-dose lysosomal -storage disorder AnIsotretinoinphenothiazine idiosyncratic drug use? reaction(Accutane) consisting of tonic upward deviation of the eyes Do verticillate resolve with cessation of theCauses drug? nyctalopia Corneal verticillata Which enzyme is deficient in Fabry’s? Yes WhichRifabutin class of drugs is most commonly implicated?Galactosidase A  Yellow tinting of The neuroleptics, duh Name three other meds,What otherand one signs/symptoms metabolicvision dz are, characteristic of Fabry’s… What other class of med is associatedclassic for inducingwith cornealIn oculogyric childhood: verticillata crisis?: Digitalis Which antiemetic is most commonly implicated? The antiemetics --Fabry’s dz --Severe extremity painCauses uveitis with Metoclopramide --Amiodarone --Angiokeratomas hypopyon What medicine can be used-- toIndomethacin break the crisis? Anticholinergics In early adulthood: --Thorazine --Cardiovascular problems --Hydroxychloroquine--Renal failure --Seizures 54 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  ThioridazineWhat class of medicine (isMellaril chlorpromazine?) It is a phenothiazine doses <800 mg/d What are corneal verticillata? Whorl-shaped pigmented deposits found in the  TamoxifenWhat sort of med are phenothiazines? Blair Witch cataract inferior interpalpebral zone of the cornea They are neuroleptics  Iritis, hypotony can  Sildenafil (Viagra)By what other name is this condition known? OtherIn addition than cataracts, to cataracts, what whatclinically ophthalmic significant effects ophthalmic does occurrence can be ‘Vortex keratopathy’ develop inducedhigh-dose by chlorpromazine? chlorpromazine therapy have? OculogyricIt causes crisis pigmentation of the lids and conj  Causes a crystalline Cidofovir Are they visually significant? What class of metabolic disorder is Fabry’s? What is an ‘oculogyric crisisOnly’? rarely retinopathy  What corneal finding is associated with highA-dose lysosomal -storage disorder AnIsotretinoinphenothiazine idiosyncratic drug use? reaction(Accutane) consisting of tonic upward deviation of the eyes Do verticillate resolve with cessation of theCauses drug? nyctalopia Corneal verticillata Which enzyme is deficient in Fabry’s? Yes WhichRifabutin class of drugs is most commonly implicated?Galactosidase A  Yellow tinting of The neuroleptics, duh Name three other meds,What otherand one signs/symptoms metabolicvision dz are, characteristic of Fabry’s… What other class of med is associatedclassic for inducingwith cornealIn oculogyric childhood: verticillata crisis?: Digitalis Which antiemetic is most commonly implicated? The antiemetics --Fabry’s dz --Severe extremity painCauses uveitis with Metoclopramide --Amiodarone --Angiokeratomas hypopyon What medicine can be used-- toIndomethacin break the crisis? Anticholinergics In early adulthood: --Thorazine --Cardiovascular problems --Hydroxychloroquine--Renal failure --Seizures 55

Systemic drugs and ocular toxicity: Matching

Oculogyric crisis 2ndry to metoclopramide 56 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  ThioridazineWhat class of medicine (isMellaril chlorpromazine?) It is a phenothiazine doses <800 mg/d What are corneal verticillata? Whorl-shaped pigmented deposits found in the  TamoxifenWhat sort of med are phenothiazines? Blair Witch cataract inferior interpalpebral zone of the cornea They are neuroleptics  Iritis, hypotony can  Sildenafil (Viagra)By what other name is this condition known? OtherIn addition than cataracts, to cataracts, what whatclinically ophthalmic significant effects ophthalmic does occurrence can be ‘Vortex keratopathy’ develop inducedhigh-dose by chlorpromazine? chlorpromazine therapy have? OculogyricIt causes crisis pigmentation of the lids and conj  Causes a crystalline Cidofovir Are they visually significant? What class of metabolic disorder is Fabry’s? What is an ‘oculogyric crisisOnly’? rarely retinopathy  What corneal finding is associated with highA-dose lysosomal -storage disorder AnIsotretinoinphenothiazine idiosyncratic drug use? reaction(Accutane) consisting of tonic upward deviation of the eyes Do verticillate resolve with cessation of theCauses drug? nyctalopia Corneal verticillata Which enzyme is deficient in Fabry’s? Yes WhichRifabutin class of drugs is most commonly implicated?Galactosidase A  Yellow tinting of The neuroleptics, duh Name three other meds,What otherand one signs/symptoms metabolicvision dz are, characteristic of Fabry’s…  associated with corneal verticillata: WhatDigitalis other class of med is classic for inducingIn oculogyric childhood: crisis? The antiemetics --Fabry’s dz --Severe extremity painCauses uveitis with --Amiodarone --Angiokeratomas hypopyon What medicine can be used-- toIndomethacin break an oculogyric crisis? Anticholinergics In early adulthood: --Thorazine --Cardiovascular problems --Hydroxychloroquine--Renal failure --Seizures 57 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  ThioridazineWhat class of medicine (isMellaril chlorpromazine?) It is a phenothiazine doses <800 mg/d What are corneal verticillata? Whorl-shaped pigmented deposits found in the  TamoxifenWhat sort of med are phenothiazines? Blair Witch cataract inferior interpalpebral zone of the cornea They are neuroleptics  Iritis, hypotony can  Sildenafil (Viagra)By what other name is this condition known? OtherIn addition than cataracts, to cataracts, what whatclinically ophthalmic significant effects ophthalmic does occurrence can be ‘Vortex keratopathy’ develop inducedhigh-dose by chlorpromazine? chlorpromazine therapy have? OculogyricIt causes crisis pigmentation of the lids and conj  Causes a crystalline Cidofovir Are they visually significant? What class of metabolic disorder is Fabry’s? What is an ‘oculogyric crisisOnly’? rarely retinopathy  What corneal finding is associated with highA-dose lysosomal -storage disorder AnIsotretinoinphenothiazine idiosyncratic drug use? reaction(Accutane) consisting of tonic upward deviation of the eyes Do verticillate resolve with cessation of theCauses drug? nyctalopia Corneal verticillata Which enzyme is deficient in Fabry’s? Yes WhichRifabutin class of drugs is most commonly implicated?Galactosidase A  Yellow tinting of The neuroleptics, duh Name three other meds,What otherand one signs/symptoms metabolicvision dz are, characteristic of Fabry’s…  associated with corneal verticillata: WhatDigitalis other class of med is classic for inducingIn oculogyric childhood: crisis? The antiemetics --Fabry’s dz --Severe extremity painCauses uveitis with --Amiodarone --Angiokeratomas hypopyon What medicine can be used-- toIndomethacin break an oculogyric crisis? Anticholinergics In early adulthood: --Thorazine --Cardiovascular problems --Hydroxychloroquine--Renal failure --Seizures 58 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  ThioridazineWhat class of medicine (isMellaril chlorpromazine?) It is a phenothiazine doses <800 mg/d What are corneal verticillata? Whorl-shaped pigmented deposits found in the  TamoxifenWhat sort of med are phenothiazines? Blair Witch cataract inferior interpalpebral zone of the cornea They are neuroleptics  Iritis, hypotony can  Sildenafil (Viagra)By what other name is this condition known? OtherIn addition than cataracts, to cataracts, what whatclinically ophthalmic significant effects ophthalmic does occurrence can be ‘Vortex keratopathy’ develop inducedhigh-dose by chlorpromazine? chlorpromazine therapy have? OculogyricIt causes crisis pigmentation of the lids and conj  Causes a crystalline Cidofovir Are they visually significant? What class of metabolic disorder is Fabry’s? What is an ‘oculogyric crisisOnly’? rarely retinopathy  What corneal finding is associated with highA-dose downwardlysosomal -storage disorder AnIsotretinoinphenothiazine idiosyncratic drug use? reaction(Accutane) consisting of tonic upward deviation of the eyes Do verticillate resolve with cessation of theCauses drug? nyctalopia Corneal verticillata Which enzyme is deficient in Fabry’s? OculogyricYes crisis involves tonic upward deviation of the eyes, and an inability WhichRifabutin class of drugs is most commonly implicated?Galactosidase A  Yellow tinting of The neuroleptics, duhlooking downward. There is a condition that presents in the opposite fashion, ie, with a tonic downward gaze, and difficulty looking up. What is it? Name three other meds,What otherand one signs/symptoms metabolicvision dz are, characteristic of Fabry’s…  Parinaudassociated syndrome with corneal qerfvqev verticillata: WhatDigitalis other class of med is classic for inducingIn oculogyric childhood: crisis? The antiemetics --Fabry’s dz --Severe extremity painCauses uveitis with Parinaud--Amiodarone syndrome has --fourAngiokeratomas classic clinical features. One is impaired upgaze. What are the other three? hypopyon What medicine can be used-- toIndomethacin break an oculogyric crisis? Anticholinergics --Impaired upgaze In early adulthood: --Light---Tnearhorazine dissociation--Cardiovascular problems --Lid --retractionHydroxychloroquine--Renal failure --Convergence-retraction-- Seizuresnystagmus 59 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  ThioridazineWhat class of medicine (isMellaril chlorpromazine?) It is a phenothiazine doses <800 mg/d What are corneal verticillata? Whorl-shaped pigmented deposits found in the  TamoxifenWhat sort of med are phenothiazines? Blair Witch cataract inferior interpalpebral zone of the cornea They are neuroleptics  Iritis, hypotony can  Sildenafil (Viagra)By what other name is this condition known? OtherIn addition than cataracts, to cataracts, what whatclinically ophthalmic significant effects ophthalmic does occurrence can be ‘Vortex keratopathy’ develop inducedhigh-dose by chlorpromazine? chlorpromazine therapy have? OculogyricIt causes crisis pigmentation of the lids and conj  Causes a crystalline Cidofovir Are they visually significant? What class of metabolic disorder is Fabry’s? What is an ‘oculogyric crisisOnly’? rarely retinopathy  What corneal finding is associated with highA-dose downwardlysosomal -storage disorder AnIsotretinoinphenothiazine idiosyncratic drug use? reaction(Accutane) consisting of tonic upward deviation of the eyes Do verticillate resolve with cessation of theCauses drug? nyctalopia Corneal verticillata Which enzyme is deficient in Fabry’s? OculogyricYes crisis involves tonic upward deviation of the eyes, and an inability WhichRifabutin class of drugs is most commonly implicated?Galactosidase A  Yellow tinting of The neuroleptics, duhlooking downward. There is a condition that presents in the opposite fashion, ie, with a tonic downward gaze, and difficulty looking up. What is it? Name three other meds,What otherand one signs/symptoms metabolicvision dz are, characteristic of Fabry’s…  Parinaudassociated syndrome with corneal qerfvqev verticillata: WhatDigitalis other class of med is classic for inducingIn oculogyric childhood: crisis? The antiemetics --Fabry’s dz --Severe extremity painCauses uveitis with Parinaud--Amiodarone syndrome has --fourAngiokeratomas classic clinical features. One is impaired upgaze. What are the other three? hypopyon What medicine can be used-- toIndomethacin break an oculogyric crisis? Anticholinergics --Impaired upgaze In early adulthood: --Light---Tnearhorazine dissociation--Cardiovascular problems --Lid --retractionHydroxychloroquine--Renal failure --Convergence-retraction-- Seizuresnystagmus 60 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  ThioridazineWhat class of medicine (isMellaril chlorpromazine?) It is a phenothiazine doses <800 mg/d What are corneal verticillata? Whorl-shaped pigmented deposits found in the  TamoxifenWhat sort of med are phenothiazines? Blair Witch cataract inferior interpalpebral zone of the cornea They are neuroleptics  Iritis, hypotony can  Sildenafil (Viagra)By what other name is this condition known? OtherIn addition than cataracts, to cataracts, what whatclinically ophthalmic significant effects ophthalmic does occurrence can be ‘Vortex keratopathy’ develop inducedhigh-dose by chlorpromazine? chlorpromazine therapy have? OculogyricIt causes crisis pigmentation of the lids and conj  Causes a crystalline Cidofovir Are they visually significant? What class of metabolic disorder is Fabry’s? What is an ‘oculogyric crisisOnly’? rarely retinopathy  What corneal finding is associated with highA-dose downwardlysosomal -storage disorder AnIsotretinoinphenothiazine idiosyncratic drug use? reaction(Accutane) consisting of tonic upward deviation of the eyes Do verticillate resolve with cessation of theCauses drug? nyctalopia Corneal verticillata Which enzyme is deficient in Fabry’s? OculogyricYes crisis involves tonic upward deviation of the eyes, and an inability WhichRifabutin class of drugs is most commonly implicated?Galactosidase A  Yellow tinting of The neuroleptics, duhlooking downward. There is a condition that presents in the opposite fashion, ie, with a tonic downward gaze, and difficulty looking up. What is it? Name three other meds,What otherand one signs/symptoms metabolicvision dz are, characteristic of Fabry’s…  Parinaudassociated syndrome with corneal qerfvqev verticillata: WhatDigitalis other class of med is classic for inducingIn oculogyric childhood: crisis? The antiemetics --Fabry’s dz --Severe extremity painCauses uveitis with Parinaud--Amiodarone syndrome has --fourAngiokeratomas classic clinical features. One is impaired upgaze. What are the other three? hypopyon What medicine can be used-- toIndomethacin break an oculogyric crisis? Anticholinergics --Impaired upgaze In early adulthood: -- --Thorazine --Cardiovascular problems -- --Hydroxychloroquine--Renal failure -- --Seizures 61 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  ThioridazineWhat class of medicine (isMellaril chlorpromazine?) It is a phenothiazine doses <800 mg/d What are corneal verticillata? Whorl-shaped pigmented deposits found in the  TamoxifenWhat sort of med are phenothiazines? Blair Witch cataract inferior interpalpebral zone of the cornea They are neuroleptics  Iritis, hypotony can  Sildenafil (Viagra)By what other name is this condition known? OtherIn addition than cataracts, to cataracts, what whatclinically ophthalmic significant effects ophthalmic does occurrence can be ‘Vortex keratopathy’ develop inducedhigh-dose by chlorpromazine? chlorpromazine therapy have? OculogyricIt causes crisis pigmentation of the lids and conj  Causes a crystalline Cidofovir Are they visually significant? What class of metabolic disorder is Fabry’s? What is an ‘oculogyric crisisOnly’? rarely retinopathy  What corneal finding is associated with highA-dose downwardlysosomal -storage disorder AnIsotretinoinphenothiazine idiosyncratic drug use? reaction(Accutane) consisting of tonic upward deviation of the eyes Do verticillate resolve with cessation of theCauses drug? nyctalopia Corneal verticillata Which enzyme is deficient in Fabry’s? OculogyricYes crisis involves tonic upward deviation of the eyes, and an inability WhichRifabutin class of drugs is most commonly implicated?Galactosidase A  Yellow tinting of The neuroleptics, duhlooking downward. There is a condition that presents in the opposite fashion, ie, with a tonic downward gaze, and difficulty looking up. What is it? Name three other meds,What otherand one signs/symptoms metabolicvision dz are, characteristic of Fabry’s…  Parinaudassociated syndrome with corneal qerfvqev verticillata: WhatDigitalis other class of med is classic for inducingIn oculogyric childhood: crisis? The antiemetics --Fabry’s dz --Severe extremity painCauses uveitis with Parinaud--Amiodarone syndrome has --fourAngiokeratomas classic clinical features. One is impaired upgaze. What are the other three? hypopyon What medicine can be used-- toIndomethacin break an oculogyric crisis? Anticholinergics --Impaired upgaze In early adulthood: --Light---Tnearhorazine dissociation--Cardiovascular problems --Lid --retractionHydroxychloroquine--Renal failure --Convergence-retraction-- Seizuresnystagmus 62 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  ThioridazineWhat class of medicine (isMellaril chlorpromazine?) It is a phenothiazine doses <800 mg/d What are corneal verticillata? Whorl-shaped pigmented deposits found in the  TamoxifenWhat sort of med are phenothiazines? Blair Witch cataract inferior interpalpebral zone of the cornea They are neuroleptics  Iritis, hypotony can  Sildenafil (Viagra)By what other name is this condition known? OtherIn addition than cataracts, to cataracts, what whatclinically ophthalmic significant effects ophthalmic does occurrence can be ‘Vortex keratopathy’ develop inducedhigh-dose by chlorpromazine? chlorpromazine therapy have? OculogyricIt causes crisis pigmentation of the lids and conj  Causes a crystalline Cidofovir Are they visually significant? What CNS structure is involved in ParinaudWhat class syndrome? of metabolic disorder is Fabry’s? What is an ‘oculogyric crisisOnly’? rarely retinopathy  What cornealThe dorsal finding midbrain is associated with highA-dose lysosomal -storage disorder AnIsotretinoinphenothiazine idiosyncratic drug use? reaction(Accutane) consisting of tonic upward deviation of the eyes Do verticillate resolve with cessation of theCauses drug? nyctalopia CornealWhat verticillata specific dorsal midbrain componentWhich is enzymeaffected? is deficient in Fabry’s? Which class of drugs isOculogyric mostYes commonly crisis involves implicated? tonic upward deviation of the eyes, and an inability  RifabutinThe pretectal nuclei Galactosidase A  Yellow tinting of The neuroleptics, duhlooking downward. There is a condition that presents in the opposite fashion, ie, with a tonic downward gaze, and difficulty looking up. What is it? Name three other meds,What otherand one signs/symptoms metabolicvision dz are, characteristic of Fabry’s…  Parinaudassociated syndrome with corneal qerfvqev verticillata: WhatDigitalis other class of med is classic for inducingIn oculogyric childhood: crisis? The antiemetics --Fabry’s dz --Severe extremity painCauses uveitis with Parinaud--Amiodarone syndrome has --fourAngiokeratomas classic clinical features. One is impaired upgaze. What are the other three? hypopyon What medicine can be used-- toIndomethacin break an oculogyric crisis? Anticholinergics --Impaired upgaze In early adulthood: --Light---Tnearhorazine dissociation--Cardiovascular problems --Lid --retractionHydroxychloroquine--Renal failure --Convergence-retraction-- Seizuresnystagmus 63 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  ThioridazineWhat class of medicine (isMellaril chlorpromazine?) It is a phenothiazine doses <800 mg/d What are corneal verticillata? Whorl-shaped pigmented deposits found in the  TamoxifenWhat sort of med are phenothiazines? Blair Witch cataract inferior interpalpebral zone of the cornea They are neuroleptics  Iritis, hypotony can  Sildenafil (Viagra)By what other name is this condition known? OtherIn addition than cataracts, to cataracts, what whatclinically ophthalmic significant effects ophthalmic does occurrence can be ‘Vortex keratopathy’ develop inducedhigh-dose by chlorpromazine? chlorpromazine therapy have? OculogyricIt causes crisis pigmentation of the lids and conj  Causes a crystalline Cidofovir Are they visually significant? What CNS structure is involved in ParinaudWhat class syndrome? of metabolic disorder is Fabry’s? What is an ‘oculogyric crisisOnly’? rarely retinopathy  What cornealThe dorsal finding midbrain is associated with highA-dose lysosomal -storage disorder AnIsotretinoinphenothiazine idiosyncratic drug use? reaction(Accutane) consisting of tonic upward deviation of the eyes Do verticillate resolve with cessation of theCauses drug? nyctalopia CornealWhat verticillata specific dorsal midbrain componentWhich is enzymeaffected? is deficient in Fabry’s? Which class of drugs isOculogyric mostYes commonly crisis involves implicated? tonic upward deviation of the eyes, and an inability  RifabutinThe pretectal nuclei Galactosidase A  Yellow tinting of The neuroleptics, duhlooking downward. There is a condition that presents in the opposite fashion, ie, with a tonic downward gaze, and difficulty looking up. What is it? Name three other meds,What otherand one signs/symptoms metabolicvision dz are, characteristic of Fabry’s…  Parinaudassociated syndrome with corneal qerfvqev verticillata: WhatDigitalis other class of med is classic for inducingIn oculogyric childhood: crisis? The antiemetics --Fabry’s dz --Severe extremity painCauses uveitis with Parinaud--Amiodarone syndrome has --fourAngiokeratomas classic clinical features. One is impaired upgaze. What are the other three? hypopyon What medicine can be used-- toIndomethacin break an oculogyric crisis? Anticholinergics --Impaired upgaze In early adulthood: --Light---Tnearhorazine dissociation--Cardiovascular problems --Lid --retractionHydroxychloroquine--Renal failure --Convergence-retraction-- Seizuresnystagmus 64 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  ThioridazineWhat class of medicine (isMellaril chlorpromazine?) It is a phenothiazine doses <800 mg/d What are corneal verticillata? Whorl-shaped pigmented deposits found in the  TamoxifenWhat sort of med are phenothiazines? Blair Witch cataract inferior interpalpebral zone of the cornea They are neuroleptics  Iritis, hypotony can  Sildenafil (Viagra)By what other name is this condition known? OtherIn addition than cataracts, to cataracts, what whatclinically ophthalmic significant effects ophthalmic does occurrence can be ‘Vortex keratopathy’ develop inducedhigh-dose by chlorpromazine? chlorpromazine therapy have? OculogyricIt causes crisis pigmentation of the lids and conj  Causes a crystalline Cidofovir Are they visually significant? What CNS structure is involved in ParinaudWhat class syndrome? of metabolic disorder is Fabry’s? What is an ‘oculogyric crisisOnly’? rarely retinopathy  What cornealThe dorsal finding midbrain is associated with highA-dose lysosomal -storage disorder AnIsotretinoinphenothiazine idiosyncratic drug use? reaction(Accutane) consisting of tonic upward deviation of the eyes Do verticillate resolve with cessation of theCauses drug? nyctalopia CornealWhat verticillata specific dorsal midbrain componentWhich is enzymeaffected? is deficient in Fabry’s? Which class of drugs isOculogyric mostYes commonly crisis involves implicated? tonic upward deviation of the eyes, and an inability  RifabutinThe pretectal nuclei Galactosidase A  Yellow tinting of The neuroleptics, duhlooking downward. There is a condition that presents in the opposite fashion, ie, with a tonic downward gaze, and difficulty looking up. What is it? Name three other meds,What otherand one signs/symptoms metabolicvision dz are, characteristic of Fabry’s…  Parinaudassociated syndrome with corneal qerfvqev verticillata: WhatDigitalis other class of med is classic for inducingIn oculogyric childhood: crisis? The antiemetics --Fabry’s dz --Severe extremity painCauses uveitis with Parinaud--Amiodarone syndrome has --fourAngiokeratomas classic clinical features. One is impaired upgaze. What are the other three? hypopyon What medicine can be used-- toIndomethacin break an oculogyric crisis? Anticholinergics --Impaired upgaze In early adulthood: --Light---Tnearhorazine dissociation--Cardiovascular problems --Lid --retractionHydroxychloroquine--Renal failure --Convergence-retraction-- Seizuresnystagmus 65 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  ThioridazineWhat class of medicine (isMellaril chlorpromazine?) It is a phenothiazine doses <800 mg/d What are corneal verticillata? Whorl-shaped pigmented deposits found in the  TamoxifenWhat sort of med are phenothiazines? Blair Witch cataract inferior interpalpebral zone of the cornea They are neuroleptics  Iritis, hypotony can  Sildenafil (Viagra)By what other name is this condition known? OtherIn addition than cataracts, to cataracts, what whatclinically ophthalmic significant effects ophthalmic does occurrence can be ‘Vortex keratopathy’ develop inducedhigh-dose by chlorpromazine? chlorpromazine therapy have? OculogyricIt causes crisis pigmentation of the lids and conj  Causes a crystalline Cidofovir Are they visually significant? What CNS structure is involved in ParinaudWhat class syndrome? of metabolic disorder is Fabry’s? What is an ‘oculogyric crisisOnly’? rarely retinopathy  What cornealThe dorsal finding midbrain is associated with highA-dose lysosomal -storage disorder AnIsotretinoinphenothiazine idiosyncratic drug use? reaction(Accutane) consisting of tonic upward deviation of the eyes Do verticillate resolve with cessation of theCauses drug? nyctalopia CornealWhat verticillata specific dorsal midbrain componentWhich is enzymeaffected? is deficient in Fabry’s? Which class of drugs isOculogyric mostYes commonly crisis involves implicated? tonic upward deviation of the eyes, and an inability  RifabutinThe pretectal nuclei Galactosidase A  Yellow tinting of The neuroleptics, duhlooking downward. There is a condition that presents in the opposite fashion, ie, with a tonic downward gaze, and difficulty looking up. What is it? Name three other meds,What otherand one signs/symptoms metabolicvision dz are, characteristic of Fabry’s…  Parinaudassociated syndrome with corneal qerfvqev verticillata: WhatDigitalis other class of med is classic for inducingIn oculogyric childhood: crisis? The antiemetics --Fabry’s dz --Severe extremity painCauses uveitis with Parinaud--Amiodarone syndrome has --fourAngiokeratomas classic clinical features. One is impaired upgaze. What are the other three? hypopyon What medicine can be used-- toIndomethacin break an oculogyric crisis? Anticholinergics --Impaired upgaze In early adulthood: --Light---Tnearhorazine dissociation--Cardiovascular problems --Lid --retractionHydroxychloroquine--Renal failure --Convergence-retraction-- Seizuresnystagmus 66 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  ThioridazineWhat class of medicine (isMellaril chlorpromazine?) It is a phenothiazine doses <800 mg/d What are corneal verticillata? Whorl-shaped pigmented deposits found in the  TamoxifenWhat sort of med are phenothiazines? Blair Witch cataract inferior interpalpebral zone of the cornea They are neuroleptics  Iritis, hypotony can  Sildenafil (Viagra)By what other name is this condition known? OtherIn addition than cataracts, to cataracts, what whatclinically ophthalmic significant effects ophthalmic does occurrence can be ‘Vortex keratopathy’ develop inducedhigh-dose by chlorpromazine? chlorpromazine therapy have? OculogyricIt causes crisis pigmentation of the lids and conj  Causes a crystalline Cidofovir Are they visually significant? What CNS structure is involved in ParinaudWhat class syndrome? of metabolic disorder is Fabry’s? What is an ‘oculogyric crisisOnly’? rarely retinopathy  What cornealThe dorsal finding midbrain is associated with highA-dose lysosomal -storage disorder AnIsotretinoinphenothiazine idiosyncratic drug use? reaction(Accutane) consisting of tonic upward deviation of the eyes Do verticillate resolve with cessation of theCauses drug? nyctalopia CornealWhat verticillata specific dorsal midbrain componentWhich is enzymeaffected? is deficient in Fabry’s? Which class of drugs isOculogyric mostYes commonly crisis involves implicated? tonic upward deviation of the eyes, and an inability  RifabutinThe pretectal nuclei Galactosidase A  Yellow tinting of The neuroleptics, duhlooking downward. There is a condition that presents in the opposite fashion, ie, with a tonic downward gaze, and difficulty looking up. What is it? Name three other meds,What otherand one signs/symptoms metabolicvision dz are, characteristic of Fabry’s…  Parinaudassociated syndrome with corneal , aka… verticillata: WhatDigitalis other class of med is classic for inducingIn oculogyric childhood: crisis? The antiemetics --Fabry’s dz --Severe extremity painCauses uveitis with By what two noneponymous names is Parinaud syndrome also known? Parinaud--Amiodarone syndrome has --fourAngiokeratomas classic clinical features. One is impaired upgaze. WhatDorsal are the midbrain other three? syndrome and pretectalhypopyon syndrome What medicine can be used-- toIndomethacin break an oculogyric crisis? Anticholinergics --Impaired upgaze In early adulthood: --Light---Tnearhorazine dissociation--Cardiovascular problems --Lid --retractionHydroxychloroquine--Renal failure --Convergence-retraction-- Seizuresnystagmus 67 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  ThioridazineWhat class of medicine (isMellaril chlorpromazine?) It is a phenothiazine doses <800 mg/d What are corneal verticillata? Whorl-shaped pigmented deposits found in the  TamoxifenWhat sort of med are phenothiazines? Blair Witch cataract inferior interpalpebral zone of the cornea They are neuroleptics  Iritis, hypotony can  Sildenafil (Viagra)By what other name is this condition known? OtherIn addition than cataracts, to cataracts, what whatclinically ophthalmic significant effects ophthalmic does occurrence can be ‘Vortex keratopathy’ develop inducedhigh-dose by chlorpromazine? chlorpromazine therapy have? OculogyricIt causes crisis pigmentation of the lids and conj  Causes a crystalline Cidofovir Are they visually significant? What CNS structure is involved in ParinaudWhat class syndrome? of metabolic disorder is Fabry’s? What is an ‘oculogyric crisisOnly’? rarely retinopathy  What cornealThe dorsal finding midbrain is associated with highA-dose lysosomal -storage disorder AnIsotretinoinphenothiazine idiosyncratic drug use? reaction(Accutane) consisting of tonic upward deviation of the eyes Do verticillate resolve with cessation of theCauses drug? nyctalopia CornealWhat verticillata specific dorsal midbrain componentWhich is enzymeaffected? is deficient in Fabry’s? Which class of drugs isOculogyric mostYes commonly crisis involves implicated? tonic upward deviation of the eyes, and an inability  RifabutinThe pretectal nuclei Galactosidase A Yellow tinting of The neuroleptics, duhlooking downward. There is a condition that presents in the opposite fashion, ie, with a tonic downward gaze, and difficulty looking up. What is it? Name three other meds,What otherand one signs/symptoms metabolicvision dz are, characteristic of Fabry’s…  Parinaudassociated syndrome with corneal , aka…Dorsal verticillata Midbrain/Pretectal: Syndrome WhatDigitalis other class of med is classic for inducingIn oculogyric childhood: crisis? The antiemetics --Fabry’s dz --Severe extremity painCauses uveitis with By what two noneponymous names is Parinaud syndrome also known? Parinaud--Amiodarone syndrome has --fourAngiokeratomas classic clinical features. One is impaired upgaze. WhatDorsal are the midbrain other three? syndrome and pretectalhypopyon syndrome What medicine can be used-- toIndomethacin break an oculogyric crisis? Anticholinergics --Impaired upgaze In early adulthood: --Light---Tnearhorazine dissociation--Cardiovascular problems --Lid --retractionHydroxychloroquine--Renal failure --Convergence-retraction-- Seizuresnystagmus 68 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril)? doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop  Cidofovir  Causes a crystalline retinopathy  Isotretinoin (Accutane)  Causes nyctalopia  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 69 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop  Cidofovir  Causes a crystalline retinopathy  Isotretinoin (Accutane)  Causes nyctalopia  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 70 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d What class of medicine is thioridazine?  Blair Witch cataract Like chlorpromazine,Tamoxifen it is a phenothiazine  Iritis, hypotony can In a word,Sildenafil what sort of retinopathy(Viagra) does thioridazine cause? Pigmentary retinopathy develop   Does Cidofovirthioridazine-induced retinopathy vision-threatening? Causes a crystalline Yes, profound vision loss can result retinopathy  Isotretinoin (Accutane) Does thioridazine require regular monitoring for retinopathy?  Causes nyctalopia Not at normal doses, ie, less than 800 mg/d  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 71 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d What class of medicine is thioridazine?  Blair Witch cataract Like chlorpromazine,Tamoxifen it is a phenothiazine  Iritis, hypotony can In a word,Sildenafil what sort of retinopathy(Viagra) does thioridazine cause? Pigmentary retinopathy develop   Does Cidofovirthioridazine-induced retinopathy vision-threatening? Causes a crystalline Yes, profound vision loss can result retinopathy  Isotretinoin (Accutane) Does thioridazine require regular monitoring for retinopathy?  Causes nyctalopia Not at normal doses, ie, less than 800 mg/d  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 72 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d What class of medicine is thioridazine?  Blair Witch cataract Like chlorpromazine,Tamoxifen it is a phenothiazine  Iritis, hypotony can In a word,Sildenafil what sort of retinopathy(Viagra) does thioridazine cause? Pigmentary retinopathy develop   Does Cidofovirthioridazine-induced retinopathy vision-threatening? Causes a crystalline Yes, profound vision loss can result retinopathy  Isotretinoin (Accutane) Does thioridazine require regular monitoring for retinopathy?  Causes nyctalopia Not at normal doses, ie, less than 800 mg/d  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 73 A Systemic drugs and retinalocular toxicity: Matching

Systemic drugs and ocular toxicity: Matching

Thioridazine: Pigmentary retinopathy 75 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d What class of medicine is thioridazine?  Blair Witch cataract Like chlorpromazine,Tamoxifen it is a phenothiazine  Iritis, hypotony can In a word,Sildenafil what sort of retinopathy(Viagra) does thioridazine cause? Pigmentary retinopathy develop   Does Cidofovirthioridazine-induced retinopathy vision-threatening? Causes a crystalline Yes, profound vision loss can result retinopathy  Isotretinoin (Accutane) Does thioridazine require regular monitoring for retinopathy?  Causes nyctalopia Not at normal doses, ie, less than 800 mg/d  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 76 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d What class of medicine is thioridazine?  Blair Witch cataract Like chlorpromazine,Tamoxifen it is a phenothiazine  Iritis, hypotony can In a word,Sildenafil what sort of retinopathy(Viagra) does thioridazine cause? Pigmentary retinopathy develop   Does Cidofovirthioridazine-induced retinopathy vision-threatening? Causes a crystalline Yes, profound vision loss can result retinopathy  Isotretinoin (Accutane) Does thioridazine require regular monitoring for retinopathy?  Causes nyctalopia Not at normal doses, ie, less than 800 mg/d  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 77 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d What class of medicine is thioridazine?  Blair Witch cataract Like chlorpromazine,Tamoxifen it is a phenothiazine  Iritis, hypotony can In a word,Sildenafil what sort of retinopathy(Viagra) does thioridazine cause? Pigmentary retinopathy develop   Does Cidofovirthioridazine-induced retinopathy vision-threatening? Causes a crystalline Yes, profound vision loss can result retinopathy  Isotretinoin (Accutane) Does thioridazine require regular monitoring for retinopathy?  Causes nyctalopia Not at normal doses, ie, less than 800 mg/d  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 78 A Systemic drugs and retinalocular toxicity: Matching

Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d So, Tamoxifenthe phenothiazenes cause pigment-relatedchanges:Blair Witch cataract Chlorpromazine causing cataracts and verticillata Iritis,, and hypotony can Thioridazine Sildenafilcausing (Viagra) a pigmentary retinopathy develop  Cidofovir  Causes a crystalline retinopathy  Isotretinoin (Accutane)  Causes nyctalopia  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 80 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen?  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop  Cidofovir  Causes a crystalline retinopathy  Isotretinoin (Accutane)  Causes nyctalopia  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 81 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop  Cidofovir  Causes a crystalline retinopathy  Isotretinoin (Accutane)  Causes nyctalopia  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 82

Systemic drugs and ocular toxicity: Matching

Tamoxifen retinopathy 83 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop   Causes a crystalline What sortCidofovir of med is tamoxifen, and what is its mechanism of action? An antiestrogen, it works by binding the estrogen receptor retinopathy  Isotretinoin (Accutane) What is/are the most common indications for tamoxifen therapy in:  Causes nyctalopia Hormone -receptor-positive breast cancer  Rifabutin Ocular dz Yellow tinting of What is a typical daily adult dose of tamoxifen? vision 20 mg Systemic dz Digitalis  What is canthaxanthine, and what is it usedCauses for? uveitisDrug-induced with At what daily and total doses ofIt istamoxifen a carotenoid does ingested the risk of to darken the skinhypopyon (ie, a retinopathy increase? tanning substitute) Tamoxifen Daily: >200mg Other than tamoxifen, what two drugs come to mind? Canthaxanthine Cumulative: >100g Does it affect vision? Talc No 98 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop   Causes a crystalline What sortCidofovir of med is tamoxifen, and what is its mechanism of action? An antiestrogen, it works by binding the estrogen receptor retinopathy  Isotretinoin (Accutane) What is/are the most common indications for tamoxifen therapy in:  Causes nyctalopia Hormone -receptor-positive breast cancer  Rifabutin Ocular dz Yellow tinting of What is a typical daily adult dose of tamoxifen? vision 20 mg Systemic dz Digitalis  What is canthaxanthine, and what is it usedCauses for? uveitisDrug-induced with At what daily and total doses ofIt istamoxifen a carotenoid does ingested the risk of to darken the skinhypopyon (ie, a retinopathy increase? tanning substitute) Tamoxifen Daily: >200mg Other than tamoxifen, what two drugs come to mind? Canthaxanthine Cumulative: >100g Does it affect vision? Talc No 99

Systemic drugs and ocular toxicity: Matching

Canthaxanthine crystalline retinopathy 100 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop   Causes a crystalline What sortCidofovir of med is tamoxifen, and what is its mechanism of action? An antiestrogen, it works by binding the estrogen receptor retinopathy  Isotretinoin (Accutane) What is/are the most common indications for tamoxifen therapy in:  Causes nyctalopia Hormone -receptor-positive breast cancer  Rifabutin Ocular dz Yellow tinting of What is a typical daily adult dose of tamoxifen? vision 20 mg Systemic dz Digitalis  What is canthaxanthine, and what is it usedCauses for? uveitisDrug-induced with At what daily and total doses ofIt istamoxifen a carotenoid does ingested the risk of to darken the skinhypopyon (ie, a retinopathy increase? tanning substitute) Tamoxifen Daily: >200mg Other than tamoxifen, what two drugs come to mind? Canthaxanthine Cumulative: >100g Does it affect vision? Talc No 101 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop   Causes a crystalline What sortCidofovir of med is tamoxifen, and what is its mechanism of action? An antiestrogen, it works by binding the estrogen receptor retinopathy  Isotretinoin (Accutane) What is/are the most common indications for tamoxifen therapy in:  Causes nyctalopia Hormone -receptor-positive breast cancer  Rifabutin Ocular dz Yellow tinting of What is a typical daily adult dose of tamoxifen? vision 20 mg Systemic dz Digitalis  What is canthaxanthine, and what is it usedCauses for? uveitisDrug-induced with At what daily and total doses ofIt istamoxifen a carotenoid does ingested the risk of to darken the skinhypopyon (ie, a retinopathy increase? tanning substitute) Tamoxifen Daily: >200mg Other than tamoxifen, what two drugs come to mind? Canthaxanthine Cumulative: >100g Does it affect vision? Talc No 102 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop   Causes a crystalline What sortCidofovir of med is tamoxifen, and what is its mechanism of action? An antiestrogen, it works by binding the estrogen receptor retinopathy  Isotretinoin (Accutane) What is/are the most common indications for tamoxifen therapy in:  Causes nyctalopia Hormone -receptor-positive breast cancer  Rifabutin Ocular dz Yellow tinting of What is a typical daily adult dose of tamoxifen? vision 20 mg Systemic dz Digitalis  Causes uveitisDrug-induced with At what daily and total doses of tamoxifen does the risk of hypopyon retinopathy increase? Tamoxifen Daily: >200mg Other than tamoxifen, what two drugs come to mind? Canthaxanthine How does talc—a powder—get to the retina? Cumulative: >100g It is a common contaminant in compounds used Talc by IV drug users 103 A Systemic drugs and retinalocular toxicity: Matching

Systemic drugs and ocular toxicity: Matching

Talc retinopathy 105 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop   Causes a crystalline What sortCidofovir of med is tamoxifen, and what is its mechanism of action? An antiestrogen, it works by binding the estrogen receptor retinopathy  Isotretinoin (Accutane) What is/are the most common indications for tamoxifen therapy in:  Causes nyctalopia HormoneIn oneRifabutin word,-receptor what- positivesort of condition breast cancer is cystinosis?  Yellow tinting of A metabolic disorder Ocular dz What is a typical daily adult dose of tamoxifen? vision 20 mg Systemic dz What Digitalisis the metabolic issue?  The amino acid cystine cannot be properly disposed of, CystinosisCauses uveitisDrug-induced with Atand what accumulates daily and total in organs doses of tamoxifen does the risk of hypopyon retinopathy increase? Tamoxifen Canthaxanthine Daily:Which >200mg organ is most profoundly affected? (It’s not the eye) Cumulative:The kidneys, >100g resulting in Fanconi’s syndrome Talc 108 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop   Causes a crystalline What sortCidofovir of med is tamoxifen, and what is its mechanism of action? An antiestrogen, it works by binding the estrogen receptor retinopathy  Isotretinoin (Accutane) What is/are the most common indications for tamoxifen therapy in:  Causes nyctalopia HormoneIn oneRifabutin word,-receptor what- positivesort of condition breast cancer is cystinosis?  Yellow tinting of A metabolic disorder Ocular dz What is a typical daily adult dose of tamoxifen? vision 20 mg Systemic dz What Digitalisis the metabolic issue?  The amino acid cystine cannot be properly disposed of, CystinosisCauses uveitisDrug-induced with Atand what accumulates daily and total in organs doses of tamoxifen does the risk of hypopyon retinopathy increase? Tamoxifen Canthaxanthine Daily:Which >200mg organ is most profoundly affected? (It’s not the eye) Cumulative:The kidneys, >100g resulting in Fanconi’s syndrome Talc 109 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop   Causes a crystalline What sortCidofovir of med is tamoxifen, and what is its mechanism of action? An antiestrogen, it works by binding the estrogen receptor retinopathy  Isotretinoin (Accutane) What is/are the most common indications for tamoxifen therapy in:  Causes nyctalopia HormoneIn oneRifabutin word,-receptor what- positivesort of condition breast cancer is cystinosis?  Yellow tinting of A metabolic disorder Ocular dz What is a typical daily adult dose of tamoxifen? vision 20 mg Systemic dz What Digitalisis the metabolic issue?  The amino acid cystine cannot be properly disposed of, CystinosisCauses uveitisDrug-induced with Atand what accumulates daily and total in organs doses of tamoxifen does the risk of hypopyon retinopathy increase? Tamoxifen Canthaxanthine Daily:Which >200mg organ is most profoundly affected? (It’s not the eye) Cumulative:The kidneys, >100g resulting in Fanconi’s syndrome Talc 110 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop   Causes a crystalline What sortCidofovir of med is tamoxifen, and what is its mechanism of action? An antiestrogen, it works by binding the estrogen receptor retinopathy  Isotretinoin (Accutane) What is/are the most common indications for tamoxifen therapy in:  Causes nyctalopia HormoneIn oneRifabutin word,-receptor what- positivesort of condition breast cancer is cystinosis?  Yellow tinting of A metabolic disorder Ocular dz What is a typical daily adult dose of tamoxifen? vision 20 mg Systemic dz What Digitalisis the metabolic issue?  The amino acid cystine cannot be properly disposed of, CystinosisCauses uveitisDrug-induced with Atand what accumulates daily and total in organs doses of tamoxifen does the risk of hypopyon retinopathy increase? Tamoxifen Canthaxanthine Daily:Which >200mg organ is most profoundly affected? (It’s not the eye) Cumulative:The kidneys, >100g resulting in Fanconi’s syndrome Talc 111

Systemic drugs and ocular toxicity: Matching

Crystalline retinopathy in cystinosis 112 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop   Causes a crystalline What sortCidofovir of med is tamoxifen, and what is its mechanism of action? An antiestrogen, it works by binding the estrogen receptor retinopathy  Isotretinoin (Accutane) What is/are the most common indications for tamoxifen therapy in:  Causes nyctalopia HormoneIn oneRifabutin word,-receptor what- positivesort of condition breast cancer is cystinosis?  Yellow tinting of A metabolic disorder Ocular dz What is a typical daily adult dose of tamoxifen? vision 20 mg Systemic dz What Digitalisis the metabolic issue?  The amino acid cystine cannot be properly disposed of, CystinosisCauses uveitisDrug-induced with Atand what accumulates daily and total in organs doses of tamoxifen does the risk of hypopyon retinopathy increase? Tamoxifen Canthaxanthine Daily:Which >200mg organ is most profoundly affected? (It’s not the eye) Cumulative:The kidneys, >100g resulting in Fanconi’s syndrome Talc 113 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop   Causes a crystalline What sortCidofovir of med is tamoxifen, and what is its mechanism of action? An antiestrogen, it works by binding the estrogen receptor retinopathy  Isotretinoin (Accutane) What is/are the most common indications for tamoxifen therapy in:  Causes nyctalopia HormoneIn oneRifabutin word,-receptor what- positivesort of condition breast cancer is cystinosis?  Yellow tinting of A metabolic disorder Ocular dz What is a typical daily adult dose of tamoxifen? vision 20 mg Systemic dz What Digitalisis the metabolic issue?  The amino acid cystine cannot be properly disposed of, CystinosisCauses uveitisDrug-induced with Atand what accumulates daily and total in organs doses of tamoxifen does the risk of hypopyon retinopathy increase? Tamoxifen Canthaxanthine Daily:Which >200mg organ is most profoundly affected? (It’s not the eye) Cumulative:The kidneys, >100g resulting in Fanconi’s syndrome Talc 114 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop   Causes a crystalline What sortCidofovir of med is tamoxifen, and what is its mechanism of action? An antiestrogen, it works by binding the estrogen receptor retinopathy  Isotretinoin (Accutane) What is/are the most common indications for tamoxifen therapy in:  Causes nyctalopia HormoneIn oneRifabutin word,-receptor what- positivesort of condition breast cancer is cystinosis?  Yellow tinting of A metabolic disorder Ocular dz What is a typical daily adult dose of tamoxifen? vision What are the principle findings in Fanconi syndrome? 20What mg is the metabolic issue? Systemic dz --FailureDigitalis to thrivegrowth failureshort stature/dwarfism  The amino acid cystine cannot be properly disposed of, CystinosisCauses uveitis with --Rickets Drug-induced Atand what accumulates daily and total in organs doses of tamoxifen does the risk of hypopyon retinopathy--Progressive increase? renal failureESRD Tamoxifen Canthaxanthine Daily:Which >200mg organ is most profoundly affected? (It’s not the eye) >100g Cumulative:The kidneys, resulting in Fanconi’s syndrome Talc 115 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop   Causes a crystalline What sortCidofovir of med is tamoxifen, and what is its mechanism of action? An antiestrogen, it works by binding the estrogen receptor retinopathy  Isotretinoin (Accutane) What is/are the most common indications for tamoxifen therapy in:  Causes nyctalopia HormoneIn oneRifabutin word,-receptor what- positivesort of condition breast cancer is cystinosis?  Yellow tinting of A metabolic disorder Ocular dz What is a typical daily adult dose of tamoxifen? vision What are the principle findings in Fanconi syndrome? 20What mg is the metabolic issue? Systemic dz --FailureDigitalis to thrivegrowth failureshort stature/dwarfism  The amino acid cystine cannot be properly disposed of, CystinosisCauses uveitis with --Rickets Drug-induced Atand what accumulates daily and total in organs doses of tamoxifen does the risk of hypopyon retinopathy--Progressive increase? renal failureESRD Tamoxifen Canthaxanthine Daily:Which >200mg organ is most profoundly affected? (It’s not the eye) >100g Cumulative:The kidneys, resulting in Fanconi’s syndrome Talc 116 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop   Causes a crystalline What sortCidofovir of med is tamoxifen, and what is its mechanism of action? An antiestrogen, it works by binding the estrogen receptor retinopathy  Finally: The retina is not the crystal location for Isotretinoin (Accutane)  What is/are whichthe most cystinosis common indicationsis best known for tamoxifen—what is?therapy in: Causes nyctalopia HormoneIn oneRifabutin word,-receptorThe what cornea- positivesort of condition breast cancer is cystinosis?  Yellow tinting of A metabolic disorder Ocular dz What is a typical daily adult dose of tamoxifen? vision What are the principle findings in Fanconi syndrome? 20What mg is the metabolic issue? Systemic dz --FailureDigitalis to thrivegrowth failureshort stature/dwarfism  The amino acid cystine cannot be properly disposed of, CystinosisCauses uveitis with --Rickets Drug-induced Atand what accumulates daily and total in organs doses of tamoxifen does the risk of hypopyon retinopathy--Progressive increase? renal failureESRD Tamoxifen Canthaxanthine Daily:Which >200mg organ is most profoundly affected? (It’s not the eye) >100g Cumulative:The kidneys, resulting in Fanconi’s syndrome Talc 117 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop   Causes a crystalline What sortCidofovir of med is tamoxifen, and what is its mechanism of action? An antiestrogen, it works by binding the estrogen receptor retinopathy  Finally: The retina is not the crystal location for Isotretinoin (Accutane)  What is/are whichthe most cystinosis common indicationsis best known for tamoxifen—what is?therapy in: Causes nyctalopia HormoneIn oneRifabutin word,-receptorThe what cornea- positivesort of condition breast cancer is cystinosis?  Yellow tinting of A metabolic disorder Ocular dz What is a typical daily adult dose of tamoxifen? vision What are the principle findings in Fanconi syndrome? 20What mg is the metabolic issue? Systemic dz --FailureDigitalis to thrivegrowth failureshort stature/dwarfism  The amino acid cystine cannot be properly disposed of, CystinosisCauses uveitis with --Rickets Drug-induced Atand what accumulates daily and total in organs doses of tamoxifen does the risk of hypopyon retinopathy--Progressive increase? renal failureESRD Tamoxifen Canthaxanthine Daily:Which >200mg organ is most profoundly affected? (It’s not the eye) >100g Cumulative:The kidneys, resulting in Fanconi’s syndrome Talc 118

Systemic drugs and ocular toxicity: Matching

Corneal crystals in cystinosis 119 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop What sort of condition is Bietti, ie,  which tissue is ‘dystrophied’?  Causes a crystalline What sortCidofovir of med is tamoxifen, and what is its mechanism of action? A choroidal dystrophy An antiestrogen, it works by binding the estrogen receptor retinopathy  Isotretinoin (Accutane)Is it common, or rare? What is/are the most common indications for tamoxifen therapy in:  Causes nyctalopia Very rare Hormone -receptor-positive breast cancer  Rifabutin Ocular dz Yellow tinting of What is a typical daily adultBietti dose ofcrystalline tamoxifen? dystrophy vision 20 mg Systemic dz Digitalis  CystinosisCauses uveitisDrug-induced with At what Whatdaily and ocular total conditiondoses of tamoxifen should comedoes the to riskmind? of hypopyon retinopathy increase? Tamoxifen Daily: >200mg Canthaxanthine Cumulative: >100g Talc 122 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop What sort of condition is Bietti, ie,  which tissue is ‘dystrophied’?  Causes a crystalline What sortCidofovir of med is tamoxifen, and what is its mechanism of action? A choroidal dystrophy An antiestrogen, it works by binding the estrogen receptor retinopathy  Isotretinoin (Accutane)Is it common, or rare? What is/are the most common indications for tamoxifen therapy in:  Causes nyctalopia Very rare Hormone -receptor-positive breast cancer  Rifabutin Ocular dz Yellow tinting of What is a typical daily adultBietti dose ofcrystalline tamoxifen? dystrophy vision 20 mg Systemic dz Digitalis  CystinosisCauses uveitisDrug-induced with At what Whatdaily and ocular total conditiondoses of tamoxifen should comedoes the to riskmind? of hypopyon retinopathy increase? Tamoxifen Daily: >200mg Canthaxanthine Cumulative: >100g Talc 123

Systemic drugs and ocular toxicity: Matching

Bietti crystalline dystrophy 124 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  TamoxifenWhen you hear choroidal dystrophy, two other  Blair Witch cataract conditions should come to mind immediately—  Iritis, hypotony can  what are they? Sildenafil-- (Viagra) develop -- What sort of condition is Bietti, ie,  which tissue is ‘dystrophied’?  Causes a crystalline What sortCidofovir of med is tamoxifen, and what is its mechanism of action? A choroidal dystrophy An antiestrogen, it works by binding the estrogen receptor retinopathy  Isotretinoin (Accutane)Is it common, or rare? What is/are the most common indications for tamoxifen therapy in:  Causes nyctalopia Very rare Hormone -receptor-positive breast cancer  Rifabutin Ocular dz Yellow tinting of What is a typical daily adultBietti dose ofcrystalline tamoxifen? dystrophy vision 20 mg Systemic dz Digitalis  CystinosisCauses uveitisDrug-induced with At what Whatdaily and ocular total conditiondoses of tamoxifen should comedoes the to riskmind? of hypopyon retinopathy increase? Tamoxifen Daily: >200mg Canthaxanthine Cumulative: >100g Talc 125 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  TamoxifenWhen you hear choroidal dystrophy, two other  Blair Witch cataract conditions should come to mind immediately—  Iritis, hypotony can  Sildenafilwhat are they? (Viagra) --Choroideremia develop --Gyrate atrophy What sort of condition is Bietti, ie,  which tissue is ‘dystrophied’?  Causes a crystalline What sortCidofovir of med is tamoxifen, and what is its mechanism of action? A choroidal dystrophy An antiestrogen, it works by binding the estrogen receptor retinopathy  Isotretinoin (Accutane)Is it common, or rare? What is/are the most common indications for tamoxifen therapy in:  Causes nyctalopia Very rare Hormone -receptor-positive breast cancer  Rifabutin Ocular dz Yellow tinting of What is a typical daily adultBietti dose ofcrystalline tamoxifen? dystrophy vision 20 mg Systemic dz Digitalis  CystinosisCauses uveitisDrug-induced with At what Whatdaily and ocular total conditiondoses of tamoxifen should comedoes the to riskmind? of hypopyon retinopathy increase? Tamoxifen Daily: >200mg Canthaxanthine Cumulative: >100g Talc 126 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop What sort of condition is Bietti, ie,  which tissue is ‘dystrophied’?  Causes a crystalline What sortCidofovir of med is tamoxifen, and what is its mechanism of action? A choroidal dystrophy An antiestrogen, it works by binding the estrogen receptor retinopathy  Isotretinoin (Accutane)Is it common, or rare? What is/are the most common indications for tamoxifen therapy in:  Causes nyctalopia Very rare Hormone -receptor-positive breast cancer  Rifabutin Ocular dz Yellow tinting of What is a typical daily adultBietti dose ofcrystalline tamoxifen? dystrophy vision 20 mg Systemic dz Digitalis  CystinosisCauses uveitisDrug-induced with At what Whatdaily and ocular total conditiondoses of tamoxifen should comedoes the to riskmind? of hypopyon retinopathy increase? Tamoxifen Daily: >200mg Canthaxanthine Cumulative: >100g Talc 127 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop What sort of condition is Bietti, ie,  which tissue is ‘dystrophied’?  Causes a crystalline What sortCidofovir of med is tamoxifen, and what is its mechanism of action? A choroidal dystrophy An antiestrogen, it works by binding the estrogen receptor retinopathy  Isotretinoin (Accutane)Is it common, or rare? What is/are the most common indications for tamoxifen therapy in:  Causes nyctalopia Very rare Hormone -receptor-positive breast cancer  Rifabutin Ocular dz Yellow tinting of What is a typical daily adultBietti dose ofcrystalline tamoxifen? dystrophy vision 20 mg Systemic dz Digitalis  CystinosisCauses uveitisDrug-induced with At what Whatdaily and ocular total conditiondoses of tamoxifen should comedoes the to riskmind? of hypopyon retinopathy increase? Tamoxifen Daily: >200mg Canthaxanthine Cumulative: >100g Talc 128 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen and…  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop   Causes a crystalline What sortCidofovir of med is tamoxifen, and what is its mechanism of action? An antiestrogen, it works by binding the estrogen receptor retinopathy  Isotretinoin (Accutane)  WhatFinally is/are: Tamoxifen the most common is a retinopathy indications risk forfactor tamoxifen in and oftherapy itself. in:However,Causes its usage is alsonyctalopia a risk Hormonefactor when-receptor combined-positive with breast another, cancer more common drug. That is, concomitantYellow tamoxifen tinting use of is aRifabutin risk factor for the retinopathy associated with this other drug. What is this drug? WhatHydroxychloroquine is a typical daily adult (Plaquenil) dose of tamoxifen? vision 20 mgDigitalis Does tamoxifen cause or exacerbate a crystalline maculopathy in conjunctionCauses with Plaquenil? uveitis with At whatNo, it dailyincreases and total the doseslikelihood of tamoxifen of a Plaquenil does- inducedthe risk of bull’s eye maculopathyhypopyon retinopathy increase? Daily: >200mg Cumulative: >100g 129 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen and…Plaquenil  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop   Causes a crystalline What sortCidofovir of med is tamoxifen, and what is its mechanism of action? An antiestrogen, it works by binding the estrogen receptor retinopathy  Isotretinoin (Accutane)  WhatFinally is/are: Tamoxifen the most common is a retinopathy indications risk forfactor tamoxifen in and oftherapy itself. in:However,Causes its usage is alsonyctalopia a risk Hormonefactor when-receptor combined-positive with breast another, cancer more common drug. That is, concomitantYellow tamoxifen tinting use of is aRifabutin risk factor for the retinopathy associated with this other drug. What is this drug? WhatHydroxychloroquine is a typical daily adult (Plaquenil) dose of tamoxifen? vision 20 mgDigitalis Does tamoxifen cause or exacerbate a crystalline maculopathy in conjunctionCauses with Plaquenil? uveitis with At whatNo, it dailyincreases and total the doseslikelihood of tamoxifen of a Plaquenil does- inducedthe risk of bull’s eye maculopathyhypopyon retinopathy increase? Daily: >200mg Cumulative: >100g 130 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen and…Plaquenil  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop   Causes a crystalline What sortCidofovir of med is tamoxifen, and what is its mechanism of action? An antiestrogen, it works by binding the estrogen receptor retinopathy?  Isotretinoin (Accutane)  WhatFinally is/are: Tamoxifen the most common is a retinopathy indications risk forfactor tamoxifen in and oftherapy itself. in:However,Causes its usage is alsonyctalopia a risk Hormonefactor when-receptor combined-positive with breast another, cancer more common drug. That is, concomitantYellow tamoxifen tinting use of is aRifabutin risk factor for the retinopathy associated with this other drug. What is this drug? WhatHydroxychloroquine is a typical daily adult (Plaquenil) dose of tamoxifen? vision 20 mgDigitalis Does tamoxifen in conjunction with Plaquenil cause or exacerbate a crystallineCauses maculopathy? uveitis with At whatNo, it dailyincreases and total the doseslikelihood of tamoxifen of a Plaquenil does- inducedthe risk of bull’s eye maculopathyhypopyon retinopathy increase? Daily: >200mg Cumulative: >100g 131 Q/A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen and…Plaquenil  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop   Causes a crystalline What sortCidofovir of med is tamoxifen, and what is its mechanism of action? An antiestrogen, it works by binding the estrogen receptor retinopathy?  Isotretinoin (Accutane)  WhatFinally is/are: Tamoxifen the most common is a retinopathy indications risk forfactor tamoxifen in and oftherapy itself. in:However,Causes its usage is alsonyctalopia a risk Hormonefactor when-receptor combined-positive with breast another, cancer more common drug. That is, concomitantYellow tamoxifen tinting use of is aRifabutin risk factor for the retinopathy associated with this other drug. What is this drug? WhatHydroxychloroquine is a typical daily adult (Plaquenil) dose of tamoxifen? vision 20 mgDigitalis Does tamoxifen in conjunction with Plaquenil cause or exacerbate a crystallineCauses maculopathy? uveitis with At whatNo, it dailyincreases and total the doseslikelihood of tamoxifen of a Plaquenil does- inducedthe risk of bull’s two words eye maculopathyhypopyon retinopathy increase? Daily: >200mg Cumulative: >100g 132 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen and…Plaquenil  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop   Causes a crystalline What sortCidofovir of med is tamoxifen, and what is its mechanism of action? bull’s eye An antiestrogen, it works by binding the estrogen receptor retinopathymaculopathy!  Isotretinoin (Accutane)  WhatFinally is/are: Tamoxifen the most common is a retinopathy indications risk forfactor tamoxifen in and oftherapy itself. in:However,Causes its usage is alsonyctalopia a risk Hormonefactor when-receptor combined-positive with breast another, cancer more common drug. That is, concomitantYellow tamoxifen tinting use of is aRifabutin risk factor for the retinopathy associated with this other drug. What is this drug? WhatHydroxychloroquine is a typical daily adult (Plaquenil) dose of tamoxifen? vision 20 mgDigitalis Does tamoxifen in conjunction with Plaquenil cause or exacerbate a crystallineCauses maculopathy? uveitis with At whatNo, it dailyincreases and total the doseslikelihood of tamoxifen of a Plaquenil does- inducedthe risk of bull’s eye maculopathyhypopyon retinopathy increase? Daily: >200mg Cumulative: >100g 133

Systemic drugs and ocular toxicity: Matching

Tamoxifen + Plaquenil: Bull’s eye maculopathy 134 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra)? develop  Cidofovir  Causes a crystalline retinopathy  Isotretinoin (Accutane)  Causes nyctalopia  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 135 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop  Cidofovir  Causes a crystalline retinopathy  Isotretinoin (Accutane)  Causes nyctalopia  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 136 Q Systemic drugs and retinalocular toxicity: Matching

 Cidofovir Is it all PDE5 inhibitors, Causes or just sildenafil? a crystalline All of them can have retinopathythis affect  Isotretinoin (Accutane) Are the effects reversible? Causes nyctalopia Yes  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 137 A Systemic drugs and retinalocular toxicity: Matching

 Cidofovir Is it all PDE5 inhibitors, Causes or just sildenafil? a crystalline All of them can have retinopathythis affect  Isotretinoin (Accutane) Are the effects reversible? Causes nyctalopia Yes  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 138 Q Systemic drugs and retinalocular toxicity: Matching

 Cidofovir Is it all PDE5 inhibitors, Causes or just sildenafil? a crystalline All of them can have retinopathythis affect  Isotretinoin (Accutane) Are the effects reversible? Causes nyctalopia Yes  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 139 A Systemic drugs and retinalocular toxicity: Matching

 Cidofovir Is it all PDE5 inhibitors, Causes or just sildenafil? a crystalline All of them can have retinopathythis affect  Isotretinoin (Accutane) Are the effects reversible? Causes nyctalopia Yes  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 140 Q Systemic drugs and retinalocular toxicity: Matching

 Cidofovir Is it all PDE5 inhibitors, Causes or just sildenafil? a crystalline All of them can have retinopathythis affect  Isotretinoin (Accutane) Are the effects reversible? Causes nyctalopia Yes  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 141 A Systemic drugs and retinalocular toxicity: Matching

 Cidofovir Is it all PDE5 inhibitors, Causes or just sildenafil? a crystalline All of them can have retinopathythis effect  Isotretinoin (Accutane) Are the effects reversible? Causes nyctalopia Yes  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 142 Q Systemic drugs and retinalocular toxicity: Matching

 Cidofovir Is it all PDE5 inhibitors, Causes or just sildenafil? a crystalline All of them can have retinopathythis effect  Isotretinoin (Accutane) Are the effects reversible? Causes nyctalopia Yes  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 143 A Systemic drugs and retinalocular toxicity: Matching

 Cidofovir Is it all PDE5 inhibitors, Causes or just sildenafil? a crystalline All of them can have retinopathythis effect  Isotretinoin (Accutane) Are the effects reversible? Causes nyctalopia Yes  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 144 Q Systemic drugs and retinalocular toxicity: Matching

Systemic drugs and ocular toxicity: Matching

FA OCT

CSR-like finding in a sildenafil pt 147 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) What class of med is dosessildenafil? <800 mg/d It is a phosphodiesterase-5 (PDE5) inhibitor  Tamoxifen  Blair Witch cataract How do PDE5 inhibitors affect vision? What does MEK stand for in this context? Because they have aIritis, modest inhibitory hypotony effect on PDEcan-6,  Sildenafil (Viagra) Don’t ask--it’s complicated an enzyme in the phototransductiondevelop process Sildenafil has another, unrelated ocular effect. What is it?MEK inhibitor-associated retinopathy called?  Is it all PDE5 inhibitors, Causes or just sildenafil? a crystalline It can causeCidofovir serous retinal detachments, mimickingIt is called ‘MEK inhibitor-associated retinopathy’ (MEKAR) central serous chorioretinopathy (CSCR) All of them can have retinopathythis effect  How prevalent is MEKAR? Isotretinoin (Accutane) Are the effects reversible? Is thisWhat manifestation med is the common,classic cause or rare? of CSCR? Very--estimates run as highCauses as 90% of MEKi nyctalopiausers will It is Corticosteroidsquite rare Yes  Rifabutin experience MEKAR  Yellow tinting of What (other) med is yet another cause of CSCR?What is the classic findingvision on exam? (You’ve probably never heard of it--I know IMultifocal hadn’t.) serous RDs throughout the posterior poles OU MEKDigitalis inhibitors  Causes uveitis with How visually significant ishypopyon MEKAR? What are MEK inhibitors used to treat? Not very--most pts are asymptomatic, or only slight affected Metastatic cancer Is MEKAR an indication to stop the MEKi? No 156 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) What class of med is dosessildenafil? <800 mg/d It is a phosphodiesterase-5 (PDE5) inhibitor  Tamoxifen  Blair Witch cataract How do PDE5 inhibitors affect vision? What does MEK stand for in this context? Because they have aIritis, modest inhibitory hypotony effect on PDEcan-6,  Sildenafil (Viagra) Don’t ask--it’s complicated an enzyme in the phototransductiondevelop process Sildenafil has another, unrelated ocular effect. What is it?MEK inhibitor-associated retinopathy called?  Is it all PDE5 inhibitors, Causes or just sildenafil? a crystalline It can causeCidofovir serous retinal detachments, mimickingIt is called ‘MEK inhibitor-associated retinopathy’ (MEKAR) central serous chorioretinopathy (CSCR) All of them can have retinopathythis effect  How prevalent is MEKAR? Isotretinoin (Accutane) Are the effects reversible? Is thisWhat manifestation med is the common,classic cause or rare? of CSCR? Very--estimates run as highCauses as 90% of MEKi nyctalopiausers will It is Corticosteroidsquite rare Yes  Rifabutin experience MEKAR  Yellow tinting of What (other) med is yet another cause of CSCR?What is the classic findingvision on exam? (You’ve probably never heard of it--I know IMultifocal hadn’t.) serous RDs throughout the posterior poles OU MEKDigitalis inhibitors  Causes uveitis with How visually significant ishypopyon MEKAR? What are MEK inhibitors used to treat? Not very--most pts are asymptomatic, or only slight affected Metastatic cancer Is MEKAR an indication to stop the MEKi? No 157 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) What class of med is dosessildenafil? <800 mg/d It is a phosphodiesterase-5 (PDE5) inhibitor  Tamoxifen  Blair Witch cataract How do PDE5 inhibitors affect vision? What does MEK stand for in this context? Because they have aIritis, modest inhibitory hypotony effect on PDEcan-6,  Sildenafil (Viagra) Don’t ask--it’s complicated an enzyme in the phototransductiondevelop process Sildenafil has another, unrelated ocular effect. What is it?MEK inhibitor-associated retinopathy called?  Is it all PDE5 inhibitors, Causes or just sildenafil? a crystalline It can causeCidofovir serous retinal detachments, mimickingIt is called ‘MEK inhibitor-associated retinopathy’ (MEKAR) central serous chorioretinopathy (CSCR) All of them can have retinopathythis effect  How prevalent is MEKAR? Isotretinoin (Accutane) Are the effects reversible? Is thisWhat manifestation med is the common,classic cause or rare? of CSCR? Very--estimates run as highCauses as 90% of MEKi nyctalopiausers will It is Corticosteroidsquite rare Yes  Rifabutin experience MEKAR  Yellow tinting of What (other) med is yet another cause of CSCR?What is the classic findingvision on exam? (You’ve probably never heard of it--I know IMultifocal hadn’t.) serous RDs throughout the posterior poles OU MEKDigitalis inhibitors  Causes uveitis with How visually significant ishypopyon MEKAR? What are MEK inhibitors used to treat? Not very--most pts are asymptomatic, or only slight affected Metastatic cancer Is MEKAR an indication to stop the MEKi? No 158 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) What class of med is dosessildenafil? <800 mg/d It is a phosphodiesterase-5 (PDE5) inhibitor  Tamoxifen  Blair Witch cataract How do PDE5 inhibitors affect vision? What does MEK stand for in this context? Because they have aIritis, modest inhibitory hypotony effect on PDEcan-6,  Sildenafil (Viagra) Don’t ask--it’s complicated an enzyme in the phototransductiondevelop process Sildenafil has another, unrelated ocular effect. What is it?MEK inhibitor-associated retinopathy called?  Is it all PDE5 inhibitors, Causes or just sildenafil? a crystalline It can causeCidofovir serous retinal detachments, mimickingIt is called ‘MEK inhibitor-associated retinopathy’ (MEKAR) central serous chorioretinopathy (CSCR) All of them can have retinopathythis effect  How prevalent is MEKAR? Isotretinoin (Accutane) Are the effects reversible? Is thisWhat manifestation med is the common,classic cause or rare? of CSCR? Very--estimates run as highCauses as 90% of MEKi nyctalopiausers will It is Corticosteroidsquite rare Yes  Rifabutin experience MEKAR  Yellow tinting of What (other) med is yet another cause of CSCR?What is the classic findingvision on exam? (You’ve probably never heard of it--I know IMultifocal hadn’t.) serous RDs throughout the posterior poles OU MEKDigitalis inhibitors  Causes uveitis with How visually significant ishypopyon MEKAR? What are MEK inhibitors used to treat? Not very--most pts are asymptomatic, or only slight affected Metastatic cancer Is MEKAR an indication to stop the MEKi? No 159 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) What class of med is dosessildenafil? <800 mg/d It is a phosphodiesterase-5 (PDE5) inhibitor  Tamoxifen  Blair Witch cataract How do PDE5 inhibitors affect vision? What does MEK stand for in this context? Because they have aIritis, modest inhibitory hypotony effect on PDEcan-6,  Sildenafil (Viagra) Don’t ask--it’s complicated an enzyme in the phototransductiondevelop process Sildenafil has another, unrelated ocular effect. What is it?MEK inhibitor-associated retinopathy called?  Is it all PDE5 inhibitors, Causes or just sildenafil? a crystalline It can causeCidofovir serous retinal detachments, mimickingIt is called ‘MEK inhibitor-associated retinopathy’ (MEKAR) central serous chorioretinopathy (CSCR) All of them can have retinopathythis effect  How prevalent is MEKAR? Isotretinoin (Accutane) Are the effects reversible? Is thisWhat manifestation med is the common,classic cause or rare? of CSCR? Very--estimates run as highCauses as 90% of MEKi nyctalopiausers will It is Corticosteroidsquite rare Yes  Rifabutin experience MEKAR  Yellow tinting of What (other) med is yet another cause of CSCR?What is the classic findingvision on exam? (You’ve probably never heard of it--I know IMultifocal hadn’t.) serous RDs throughout the posterior poles OU MEKDigitalis inhibitors  Causes uveitis with How visually significant ishypopyon MEKAR? What are MEK inhibitors used to treat? Not very--most pts are asymptomatic, or only slight affected Metastatic cancer Is MEKAR an indication to stop the MEKi? No 160 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) What class of med is dosessildenafil? <800 mg/d It is a phosphodiesterase-5 (PDE5) inhibitor  Tamoxifen  Blair Witch cataract How do PDE5 inhibitors affect vision? What does MEK stand for in this context? Because they have aIritis, modest inhibitory hypotony effect on PDEcan-6,  Sildenafil (Viagra) Don’t ask--it’s complicated an enzyme in the phototransductiondevelop process Sildenafil has another, unrelated ocular effect. What is it?MEK inhibitor-associated retinopathy called?  Is it all PDE5 inhibitors, Causes or just sildenafil? a crystalline It can causeCidofovir serous retinal detachments, mimickingIt is called ‘MEK inhibitor-associated retinopathy’ (MEKAR) central serous chorioretinopathy (CSCR) All of them can have retinopathythis effect  How prevalent is MEKAR? Isotretinoin (Accutane) Are the effects reversible? Is thisWhat manifestation med is the common,classic cause or rare? of CSCR? Very--estimates run as highCauses as 90% of MEK nyctalopia users will It is Corticosteroidsquite rare Yes  Rifabutin experience MEKAR  Yellow tinting of What (other) med is yet another cause of CSCR?What is the classic findingvision on exam? (You’ve probably never heard of it--I know IMultifocal hadn’t.) serous RDs throughout the posterior poles OU MEKDigitalis inhibitors  Causes uveitis with How visually significant ishypopyon MEKAR? What are MEK inhibitors used to treat? Not very--most pts are asymptomatic, or only slight affected Metastatic cancer Is MEKAR an indication to stop the MEKi? No 161 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) What class of med is dosessildenafil? <800 mg/d It is a phosphodiesterase-5 (PDE5) inhibitor  Tamoxifen  Blair Witch cataract How do PDE5 inhibitors affect vision? What does MEK stand for in this context? Because they have aIritis, modest inhibitory hypotony effect on PDEcan-6,  Sildenafil (Viagra) Don’t ask--it’s complicated an enzyme in the phototransductiondevelop process Sildenafil has another, unrelated ocular effect. What is it?MEK inhibitor-associated retinopathy called?  Is it all PDE5 inhibitors, Causes or just sildenafil? a crystalline It can causeCidofovir serous retinal detachments, mimickingIt is called ‘MEK inhibitor-associated retinopathy’ (MEKAR) central serous chorioretinopathy (CSCR) All of them can have retinopathythis effect  How prevalent is MEKAR? Isotretinoin (Accutane) Are the effects reversible? Is thisWhat manifestation med is the common,classic cause or rare? of CSCR? Very--estimates run as highCauses as 90% of MEK nyctalopia users will It is Corticosteroidsquite rare Yes  Rifabutin experience MEKAR  Yellow tinting of What (other) med is yet another cause of CSCR?What is the classic findingvision on exam? (You’ve probably never heard of it--I know IMultifocal hadn’t.) serous RDs throughout the posterior poles OU MEKDigitalis inhibitors  Causes uveitis with How visually significant ishypopyon MEKAR? What are MEK inhibitors used to treat? Not very--most pts are asymptomatic, or only slight affected Metastatic cancer Is MEKAR an indication to stop the MEKi? No 162 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) What class of med is dosessildenafil? <800 mg/d It is a phosphodiesterase-5 (PDE5) inhibitor  Tamoxifen  Blair Witch cataract How do PDE5 inhibitors affect vision? What does MEK stand for in this context? Because they have aIritis, modest inhibitory hypotony effect on PDEcan-6,  Sildenafil (Viagra) Don’t ask--it’s complicated an enzyme in the phototransductiondevelop process Sildenafil has another, unrelated ocular effect. What is it?MEK inhibitor-associated retinopathy called?  Is it all PDE5 inhibitors, Causes or just sildenafil? a crystalline It can causeCidofovir serous retinal detachments, mimickingIt is called ‘MEK inhibitor-associated retinopathy’ (MEKAR) central serous chorioretinopathy (CSCR) All of them can have retinopathythis effect  How prevalent is MEKAR? Isotretinoin (Accutane) Are the effects reversible? Is thisWhat manifestation med is the common,classic cause or rare? of CSCR? Very--estimates run as highCauses as 90% of MEK nyctalopia users will It is Corticosteroidsquite rare Yes  Rifabutin experience MEKAR  Yellow tinting of What (other) med is yet another cause of CSCR?What is the classic findingvision on exam? (You’ve probably never heard of it--I know IMultifocal hadn’t.) serous RDs throughout the posterior poles OU MEKDigitalis inhibitors  Causes uveitis with How visually significant ishypopyon MEKAR? What are MEK inhibitors used to treat? Not very--most pts are asymptomatic, or only slight affected Metastatic cancer Is MEKAR an indication to stop the MEKi? No 163

Systemic drugs and ocular toxicity: Matching

Dome configuration Caterpillar configuration

CSR-like findings in a MEKAR 164 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) What class of med is dosessildenafil? <800 mg/d It is a phosphodiesterase-5 (PDE5) inhibitor  Tamoxifen  Blair Witch cataract How do PDE5 inhibitors affect vision? What does MEK stand for in this context? Because they have aIritis, modest inhibitory hypotony effect on PDEcan-6,  Sildenafil (Viagra) Don’t ask--it’s complicated an enzyme in the phototransductiondevelop process Sildenafil has another, unrelated ocular effect. What is it?MEK inhibitor-associated retinopathy called?  Is it all PDE5 inhibitors, Causes or just sildenafil? a crystalline It can causeCidofovir serous retinal detachments, mimickingIt is called ‘MEK inhibitor-associated retinopathy’ (MEKAR) central serous chorioretinopathy (CSCR) All of them can have retinopathythis effect  How prevalent is MEKAR? Isotretinoin (Accutane) Are the effects reversible? Is thisWhat manifestation med is the common,classic cause or rare? of CSCR? Very--estimates run as highCauses as 90% of MEK nyctalopia users will It is Corticosteroidsquite rare Yes  Rifabutin experience MEKAR  Yellow tinting of What (other) med is yet another cause of CSCR?What is the classic findingvision on exam? (You’ve probably never heard of it--I know IMultifocal hadn’t.) serous RDs throughout the posterior poles OU MEKDigitalis inhibitors  Causes uveitis with How visually significant ishypopyon MEKAR? What are MEK inhibitors used to treat? Not very--most pts are asymptomatic, or only slight affected Metastatic cancer Is MEKAR an indication to stop the MEKi? No 165 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) What class of med is dosessildenafil? <800 mg/d It is a phosphodiesterase-5 (PDE5) inhibitor  Tamoxifen  Blair Witch cataract How do PDE5 inhibitors affect vision? What does MEK stand for in this context? Because they have aIritis, modest inhibitory hypotony effect on PDEcan-6,  Sildenafil (Viagra) Don’t ask--it’s complicated an enzyme in the phototransductiondevelop process Sildenafil has another, unrelated ocular effect. What is it?MEK inhibitor-associated retinopathy called?  Is it all PDE5 inhibitors, Causes or just sildenafil? a crystalline It can causeCidofovir serous retinal detachments, mimickingIt is called ‘MEK inhibitor-associated retinopathy’ (MEKAR) central serous chorioretinopathy (CSCR) All of them can have retinopathythis effect  How prevalent is MEKAR? Isotretinoin (Accutane) Are the effects reversible? Is thisWhat manifestation med is the common,classic cause or rare? of CSCR? Very--estimates run as highCauses as 90% of MEK nyctalopia users will It is Corticosteroidsquite rare Yes  Rifabutin experience MEKAR  Yellow tinting of What (other) med is yet another cause of CSCR?What is the classic findingvision on exam? (You’ve probably never heard of it--I know IMultifocal hadn’t.) serous RDs throughout the posterior poles OU MEKDigitalis inhibitors  Causes uveitis with How visually significant ishypopyon MEKAR? What are MEK inhibitors used to treat? Not very--most pts are asymptomatic, or only slight affected Metastatic cancer Is MEKAR an indication to stop the MEKi? No 166 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) What class of med is dosessildenafil? <800 mg/d It is a phosphodiesterase-5 (PDE5) inhibitor  Tamoxifen  Blair Witch cataract How do PDE5 inhibitors affect vision? What does MEK stand for in this context? Because they have aIritis, modest inhibitory hypotony effect on PDEcan-6,  Sildenafil (Viagra) Don’t ask--it’s complicated an enzyme in the phototransductiondevelop process Sildenafil has another, unrelated ocular effect. What is it?MEK inhibitor-associated retinopathy called?  Is it all PDE5 inhibitors, Causes or just sildenafil? a crystalline It can causeCidofovir serous retinal detachments, mimickingIt is called ‘MEK inhibitor-associated retinopathy’ (MEKAR) central serous chorioretinopathy (CSCR) All of them can have retinopathythis effect  How prevalent is MEKAR? Isotretinoin (Accutane) Are the effects reversible? Is thisWhat manifestation med is the common,classic cause or rare? of CSCR? Very--estimates run as highCauses as 90% of MEK nyctalopia users will It is Corticosteroidsquite rare Yes  Rifabutin experience MEKAR  Yellow tinting of What (other) med is yet another cause of CSCR?What is the classic findingvision on exam? (You’ve probably never heard of it--I know IMultifocal hadn’t.) serous RDs throughout the posterior poles OU MEKDigitalis inhibitors  Causes uveitis with How visually significant ishypopyon MEKAR? What are MEK inhibitors used to treat? Not very--most pts are asymptomatic, or only slight affected Metastatic cancer Is MEKAR an indication to stop the MEKi? No 167 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) What class of med is dosessildenafil? <800 mg/d It is a phosphodiesterase-5 (PDE5) inhibitor  Tamoxifen  Blair Witch cataract How do PDE5 inhibitors affect vision? What does MEK stand for in this context? Because they have aIritis, modest inhibitory hypotony effect on PDEcan-6,  Sildenafil (Viagra) Don’t ask--it’s complicated an enzyme in the phototransductiondevelop process Sildenafil has another, unrelated ocular effect. What is it?MEK inhibitor-associated retinopathy called?  Is it all PDE5 inhibitors, Causes or just sildenafil? a crystalline It can causeCidofovir serous retinal detachments, mimickingIt is called ‘MEK inhibitor-associated retinopathy’ (MEKAR) central serous chorioretinopathy (CSCR) All of them can have retinopathythis effect  How prevalent is MEKAR? Isotretinoin (Accutane) Are the effects reversible? Is thisWhat manifestation med is the common,classic cause or rare? of CSCR? Very--estimates run as highCauses as 90% of MEK nyctalopia users will It is Corticosteroidsquite rare Yes  Rifabutin experience MEKAR  Yellow tinting of What (other) med is yet another cause of CSCR?What is the classic findingvision on exam? (You’ve probably never heard of it--I know IMultifocal hadn’t.) serous RDs throughout the posterior poles OU MEKDigitalis inhibitors  Causes uveitis with How visually significant ishypopyon MEKAR? What are MEK inhibitors used to treat? Not very--most pts are asymptomatic, or only slight affected Metastatic cancer Is MEKAR an indication to stop the MEKi? No 168

Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) What class of med is dosessildenafil? <800 mg/d It is a phosphodiesterase-5 (PDE5) inhibitor  Tamoxifen  Blair Witch cataract How do PDE5 inhibitors affect vision? What does MEK stand for in this context? Because they have aIritis, modest inhibitory hypotony effect on PDEcan-6,  Sildenafil (Viagra) Don’t ask--it’s complicated an enzyme in the phototransductiondevelop process Sildenafil has another, unrelated ocular effect. What is it?MEK inhibitor-associated retinopathy called?  Is it all PDE5 inhibitors, Causes or just sildenafil? a crystalline It can causeCidofovir serous retinal detachments, mimickingItSo is called when ‘MEK faced inhibitor with-associated a pt with retinopathy’ apparent (MEKAR) CSCR, central serous chorioretinopathy (CSCR) beAll sure of them to inquirecan have about retinopathythis effect three meds:  How prevalent is MEKAR? Isotretinoin (Accutane)--SteroidsAre the effects reversible? Is thisWhat manifestation med is the common,classic cause or rare? of CSCR? Very--estimates run as highCauses as 90% of MEKi nyctalopiausers will Corticosteroids --SildenafilYes It is quite rare experience MEKAR   Rifabutin --MEK inhibitors Yellow tinting of What (other) med is yet another cause of CSCR?What is the classic findingvision on exam? (You’ve probably never heard of it--I know IMultifocal hadn’t.) serous RDs throughout the posterior poles OU MEKDigitalis inhibitors  Causes uveitis with How visually significant ishypopyon MEKAR? What are MEK inhibitors used to treat? Not very--most pts are asymptomatic, or only slight affected Metastatic cancer Is MEKAR an indication to stop the MEKi? No 169 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop  Cidofovir?  Causes a crystalline retinopathy  Isotretinoin (Accutane)  Causes nyctalopia  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 170 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop  Cidofovir  Causes a crystalline retinopathy  Isotretinoin (Accutane)  Causes nyctalopia  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 171 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony  Sildenafil (Viagra) can develop  Cidofovir  Causes a crystalline What is cidofovir? retinopathy  An antiviral used to treat CMV retinitis in AIDS Isotretinoin (Accutane)  Causes nyctalopia Is it given systemically?   Rifabutin Not often, because the risk of renalYellow damage is verytinting high. of Instead, it is given intravitreally. vision  Digitalis How common is anterior uveitis afterCauses intravitreal cidofovir? uveitis with It occurs in roughly 25% of cases hypopyon 172 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony  Sildenafil (Viagra) can develop  Cidofovir  Causes a crystalline What is cidofovir? retinopathy  An antiviral used to treat CMV retinitis in AIDS Isotretinoin (Accutane)  Causes nyctalopia Is it given systemically?   Rifabutin Not often, because the risk of renalYellow damage is verytinting high. of Instead, it is given intravitreally. vision  Digitalis How common is anterior uveitis afterCauses intravitreal cidofovir? uveitis with It occurs in roughly 25% of cases hypopyon 173 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony  Sildenafil (Viagra) can develop  Cidofovir  Causes a crystalline What is cidofovir? retinopathy  An antiviral used to treat CMV retinitis in AIDS Isotretinoin (Accutane)  Causes nyctalopia Is it given systemically?   Rifabutin Not often, because the risk of renalYellow damage is verytinting high. of Instead, it is given intravitreally. vision  Digitalis How common is anterior uveitis afterCauses intravitreal cidofovir? uveitis with It occurs in roughly 25% of cases hypopyon 174 Q/A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony  Sildenafil (Viagra) can develop  Cidofovir  Causes a crystalline What is cidofovir? retinopathy  An antiviral used to treat CMV retinitis in AIDS Isotretinoin (Accutane)  Causes nyctalopia Is it given systemically?   Rifabutin Not often, because the risk of renaltwoYellow damage words is verytinting high. of Instead, it is given intravitreally. vision  Digitalis How common is anterior uveitis afterCauses intravitreal cidofovir? uveitis with It occurs in roughly 25% of cases hypopyon 175 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony  Sildenafil (Viagra) can develop  Cidofovir  Causes a crystalline What is cidofovir? retinopathy  An antiviral used to treat CMV retinitis in AIDS Isotretinoin (Accutane)  Causes nyctalopia Is it given systemically?   Rifabutin Not often, because the risk of renalYellow damage is verytinting high. of Instead, it is given intravitreally. vision  Digitalis How common is anterior uveitis afterCauses intravitreal cidofovir? uveitis with It occurs in roughly 25% of cases hypopyon 176 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony  Sildenafil (Viagra) can develop  Cidofovir  Causes a crystalline What is cidofovir? retinopathy  An antiviral used to treat CMV retinitis in AIDS Isotretinoin (Accutane)  Causes nyctalopia Is it given systemically?   Rifabutin Not often, because the risk of renalYellow damage is verytinting high. of Instead, it is given intravitreally. vision  Digitalis How common is anterior uveitis afterCauses intravitreal cidofovir? uveitis with It occurs in roughly 25% of cases hypopyon 177 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony  Sildenafil (Viagra) can develop  Cidofovir  Causes a crystalline What is cidofovir? retinopathy  An antiviral used to treat CMV retinitis in AIDS Isotretinoin (Accutane)  Causes nyctalopia Is it given systemically?   Rifabutin Not often, because the risk of renalYellow damage is verytinting high. of Instead, it is given intravitreally. vision  Digitalis How common is anterior uveitis afterCauses intravitreal cidofovir? uveitis with It occurs in roughly 25% of cases hypopyon 178 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop  Cidofovir  Causes a crystalline retinopathy  Isotretinoin (Accutane)?  Causes nyctalopia  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 179 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop  Cidofovir  Causes a crystalline retinopathy  Isotretinoin (Accutane)  Causes nyctalopia  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 180 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop  Cidofovir  Causes a crystalline retinopathy  Isotretinoin (Accutane)  Causes nyctalopia In layman’s terms, what is nyctalopia?   Rifabutin Night blindness Yellow tinting of vision  Digitalis What is Accutane used to treat? Acne  Causes uveitis with hypopyon What other ocular condition is isotretinoin notorious for causing? Idiopathic intracranial hypertension, IIH (aka pseudotumor cerebri, PC) 181 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop  Cidofovir  Causes a crystalline retinopathy  Isotretinoin (Accutane)  Causes nyctalopia In layman’s terms, what is nyctalopia?   Rifabutin Night blindness Yellow tinting of vision  Digitalis What is Accutane used to treat? Acne  Causes uveitis with hypopyon What other ocular condition is isotretinoin notorious for causing? Idiopathic intracranial hypertension, IIH (aka pseudotumor cerebri, PC) 182 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop  Cidofovir  Causes a crystalline retinopathy  Isotretinoin (Accutane)  Causes nyctalopia In layman’s terms, what is nyctalopia?   Rifabutin Night blindness Yellow tinting of vision  Digitalis What is Accutane used to treat? Acne  Causes uveitis with hypopyon What other ocular condition is isotretinoin notorious for causing? Idiopathic intracranial hypertension, IIH (aka pseudotumor cerebri, PC) 183 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop  Cidofovir  Causes a crystalline retinopathy  Isotretinoin (Accutane)  Causes nyctalopia In layman’s terms, what is nyctalopia?   Rifabutin Night blindness Yellow tinting of vision  Digitalis What is Accutane used to treat? Acne  Causes uveitis with hypopyon What other ocular condition is isotretinoin notorious for causing? Idiopathic intracranial hypertension, IIH (aka pseudotumor cerebri, PC) 184 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop  Cidofovir  Causes a crystalline retinopathy  Isotretinoin (Accutane)  Causes nyctalopia In layman’s terms, what is nyctalopia?   Rifabutin Night blindness Yellow tinting of vision  Digitalis What is Accutane used to treat? Acne  Causes uveitis with hypopyon What other ocular condition is isotretinoin notorious for causing? Idiopathic intracranial hypertension, IIH (aka pseudotumor cerebri, PC) 185 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop  Cidofovir  Causes a crystalline retinopathy  Isotretinoin (Accutane)  Causes nyctalopia In layman’s terms, what is nyctalopia?   Rifabutin Night blindness Yellow tinting of vision  Digitalis What is Accutane used to treat? Acne  Causes uveitis with hypopyon What other ocular condition is isotretinoin notorious for causing? Idiopathic intracranial hypertension, IIH (aka pseudotumor cerebri, PC) 186 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop  Cidofovir  Causes a crystalline retinopathy  Isotretinoin (Accutane)  Causes nyctalopia  Rifabutin?  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 187 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop  Cidofovir  Causes a crystalline retinopathy  Isotretinoin (Accutane)  Causes nyctalopia  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 188

Systemic drugs and ocular toxicity: Matching

Rifabutin-associated uveitis with hypopyon 189 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop  Cidofovir  Causes a crystalline What is rifabutin used to treat? Mycobacterium avium complex infectionsretinopathy in AIDS pts  Isotretinoin (Accutane)  How long after initiation of treatment doesCauses the uveitis nyctalopiatypically occur?  Rifabutin Weeks to months  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 190 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop  Cidofovir  Causes a crystalline What is rifabutin used to treat? Mycobacterium avium complex infectionsretinopathy in AIDS pts  Isotretinoin (Accutane)  How long after initiation of treatment doesCauses the uveitis nyctalopiatypically occur?  Rifabutin Weeks to months  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 191 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop  Cidofovir  Causes a crystalline What is rifabutin used to treat? Mycobacterium avium complex infectionsretinopathy in AIDS pts  Isotretinoin (Accutane)  How long after initiation of treatment doesCauses the uveitis nyctalopiatypically occur?  Rifabutin Weeks to months  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 192 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop  Cidofovir  Causes a crystalline What is rifabutin used to treat? Mycobacterium avium complex infectionsretinopathy in AIDS pts  Isotretinoin (Accutane)  How long after initiation of treatment doesCauses the uveitis nyctalopiatypically occur?  Rifabutin Weeks to months  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon 193 Q Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop  Cidofovir  Causes a crystalline retinopathy  Isotretinoin (Accutane)  Causes nyctalopia  Rifabutin  Yellow tinting of vision  Digitalis?  Causes uveitis with hypopyon 194 A Systemic drugs and retinalocular toxicity: Matching

 Chlorpromazine (Thorazine)  Blue tinting of vision  Retinopathy rare at  Thioridazine (Mellaril) doses <800 mg/d  Tamoxifen  Blair Witch cataract  Iritis, hypotony can  Sildenafil (Viagra) develop  Cidofovir  Causes a crystalline retinopathy  Isotretinoin (Accutane)  Causes nyctalopia  Rifabutin  Yellow tinting of vision  Digitalis  Causes uveitis with hypopyon