Retinal Toxicity From Medications: What Patients Should Know
Originally published by Retina Group of Florida
Daily medications play an essential role in managing chronic health conditions, such as autoimmune diseases, cancer, heart conditions, and countless other medical concerns. Like any drug, prescription and over-the-counter medications can have side effects, including those that impact the eyes.
While serious retinal complications are rare, a handful of common medications with long-term use have been linked to changes in the retina, a small tissue at the back of the eye responsible for converting light into the images we see. Fortunately, many medication-related retinal changes can be detected early through routine eye examinations, allowing patients to protect their vision while also continuing to receive appropriate medical care. Here's what to know about the medications most commonly associated with retinal changes.
Medications Commonly Associated With Retinal Changes
Elmiron (Pentosan Polysulfate Sodium)
Elmiron, also known as pentosan polysulfate sodium, is a medication used to treat interstitial cystitis, a chronic condition that causes bladder pain and discomfort. Long-term use has been associated with a type of retinal damage known as pentosan polysulfate maculopathy, which primarily affects the retinal pigment epithelium (RPE) and surrounding retinal tissues.
Patients with this condition may experience difficulty reading, blurred vision, or trouble adjusting to dim lighting, although retinal changes can sometimes develop without noticeable symptoms. The risk appears to increase with greater cumulative exposure to the medication. Regular retinal examinations and imaging can help detect changes associated with Elmiron use and allow patients and their healthcare providers to discuss the safest approach to ongoing treatment.
Hydroxychloroquine
Hydroxychloroquine is commonly prescribed to treat autoimmune conditions such as lupus and rheumatoid arthritis. While it is generally considered safe, extended use can increase the risk of retinal toxicity. Over time, hydroxychloroquine can accumulate in retinal tissues and alter the retinal pigment epithelium (RPE), a layer of cells that supports and nourishes the retina's light-sensing photoreceptors. If enough damage occurs, permanent changes to central vision can develop.
The risk of retinal toxicity increases with risk factors such as pre-existing eye conditions, kidney disease, and taking additional medications associated with retinal toxicity. Because early retinal damage often causes no noticeable symptoms, patients taking hydroxychloroquine are typically advised to have a baseline eye examination followed by regular screening as recommended by their provider.
Tamoxifen
Tamoxifen is a commonly prescribed medication used to treat and help prevent the recurrence of certain types of breast cancer. With prolonged use, it can lead to small crystalline deposits forming near the macula, the center part of the retina responsible for helping you see fine details. In early stages, damage is often asymptomatic.
Less commonly, tamoxifen can cause macular edema, where fluid builds up in the retina and leads to blurred, distorted, or gradually worsening vision.
To catch retinal changes before symptoms arise, routine eye examinations are essential for patients on tamoxifen.
Antiarrhythmic Medications
Certain medications used to treat irregular heart rhythms, particularly amiodarone, have also been associated with eye-related side effects.
Most commonly, amiodarone causes harmless deposits within the cornea, the clear front surface of the eye, which rarely affect vision. More rarely, it has been linked to optic neuropathy, a condition involving damage or swelling of the optic nerve that can lead to gradual vision loss.
If you take amiodarone or a similar medication, speak to your doctor about getting regular eye exams and seek care immediately if you experience any visual changes.
Common Over-the-Counter Medications and Antidepressants
Some widely used medications, including certain antihistamines, decongestants, and antidepressants, can also affect eye health. These medications are not typically associated with retinal toxicity, but they may contribute to symptoms such as dry eyes and blurred vision.
In rare cases, these medications can trigger angle-closure glaucoma, a sudden buildup of fluid pressure in the eye that causes eye pain, redness, and a rapid drop in vision.
Symptoms That Should Prompt an Eye Examination
If you experience changes in your vision while taking any medication, they should never be ignored. Schedule a comprehensive eye exam promptly if you notice any of the following symptoms:
- Blurred or distorted vision
- Difficulty reading or recognizing faces
- Dark, blank, or missing areas in your central vision
- Changes in color perception
- New flashes of light or an increase in floaters
- A sudden decrease in vision
- Eye pain or redness, particularly if accompanied by blurred vision
Protecting Your Vision While Continuing Necessary Treatment
If you're taking medication that has been associated with retinal or other eye-related side effects, regular eye examinations are the best way to protect vision while continuing to receive the treatment you need.
These medications are often essential for managing serious medical conditions, and in most cases, the benefits of treatment outweigh the risk of vision complications. Rather than stopping a medication on your own, discuss any concerns or changes in your vision with both your prescribing physician and your retina specialist. By working together, your healthcare team can monitor your eye health, identify potential problems early, and help ensure you continue receiving the treatment you need while protecting your long-term vision.
At Retina Group of Florida, our specialists use advanced retinal imaging and comprehensive eye examinations to monitor for medication-related retinal changes and other conditions that may threaten your vision. If you've recently started a medication associated with retinal side effects, or you've noticed new or worsening vision changes while taking one, contact our team to schedule a comprehensive retinal evaluation.