Ocular Toxicology and Pharmacology Susan Schneider, MD Vice President, Retina Acucela Inc
[email protected] Ocular Toxicology “The remedy often times proves worse than the disease” - William Penn Ocular Toxicology Site Affected Ocular Toxicology: Corneal and Lenticular • Chloroquine & hydroxychloroquine • Indomethacin • Amiodarone • Tamoxifen • Suramin • Chlorpromazine (corneal endothelium) • Gold salts (chrysiasis) Causes of Corneal “Swirl” Keratopathy • Chloroquine • Suramin (used in AIDS patients) • Tamoxifen • Amiodarone Ocular Toxicology: Transient Myopia • Sulfonamides • Tetracycline • Perchlorperazine (Compazine) • Steroids • Carbonic anhydrase inhibitors Ocular Toxicology: Conjunctival, Eyelid, Scleral • Isoretinoin: DES, blepharoconjunctivitis • Chlorpromazine: Slate-blue discoloration • Niacin: Lid edema • Gold salts: Conjunctiva • Tetracycline: Conjunctival inclusion cysts • Minocycline: Bluish discoloration of sclera Ocular Toxicology: Uveal Rifabutin: • Anterior uveitis +/- vitritis, associated with hypopyon • Resolves after discontinuation of medication Ocular Toxicology: Lacrimal system Decreased tearing: Increased tearing: • Anticholinergics • Adrenergic agonists • Antihistamines • Antihypertensives • Vitamin A analogs • Cholinergic agonists • Phenothiazines • Antianxiety agents • Tricyclic antidepressants Ocular Toxicology: Retinal • Chloroquine (Aralen) & Hydroxychloroquine (Plaquenil): Bull’s eye maculopathy • Thioridazine (Mellaril): +/-decreased central vision, pigment stippling, circumscribed RPE dropout • Quinine: