Toxic retinopathies

Common toxic retinopathies:

  • Antimalarials – chloroquine / hydroxycholoroquine
  • Phenthiazines
  • Tamoxifen
  • Talc


  • Maculopathy – once ‘bull’s eye retinopathy’ develops, it is irreversible.
  • Management: Refer to RCOphth guidelines 2018.
  • Quinine toxicity –> retinal oedema, fixed dilated pupils, attenuated arterioles, constricted visual fields & optic nerve atrophy.


  • Medication for schizophrenia.
  • Thioridazine (normal dose: 150-600mg/day) – >800mg/day few wks –> toxicity.
  • Chlorpromazine (Largactil) (normal dose: 75-300mg/day) – >2400mg/day few wks –> toxicity
  • Beginning – pigmentary changes – “salt and pepper” appearance –> geographic atrophy (late stages)


  • Anti oestrogen treatment for breast carcinoma.
  • Usual dose is 20-40mg/day.
  • Vortex keratopathy and optic neuritis – rare and reversible.
  • Crystalline retinopathy.

Talc maculopathy

  • Extent corresponds with amount and duration of drug abuse (cocaine or methylphenidate/Ritalin).
  • Multiple tiny yellow-white glistening particles over posterior pole.
  • Can lead to macular oedema, flame-shaped haemorrhages and arterial occlusion with talc emboli.
  • Microtalc retinopathy – NFL defect like glaucoma.
  • Refer to respiratory physician as ocular talc indicates lung function may be compromised.

Location Birmingham Midlands Eye Centre 76 Dudley Road Birmingham B18 7QH UK Phone 0121 554 3801 Hours Mr Ch'ng | Vitreoretinal Clinic Sessions: Monday: 8.30am - 12.30pm Wednesday (alternate): 8.30am - 5.00pm Thursday: 8.30am - 12.30pm Friday: 8.30am - 12.30pm | Vitreoretinal Theatre Sessions: Wednesday (alternate): 8.30am - 5.00pm & Friday (emergency cases): 1.30pm - 5.00pm | Eye Casualty Session: Monday 1.00pm - 4.30pm |
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