Drug side effects

chloroquine

Names: Chloroquine, Nivaquine, Hydroxychloroquine (Plaquenil)

anamnesis

Dosage mg/kg body weight, indication. Start of therapy.
Indication for chloroquine: antimalarial drugs, rheumatoid arthritis, systemic lupus erythematosus (SLE)
Symptoms Eye side effects: reduced vision, reduced color vision

investigation

Baseline investigation
6-12 months after the start of medication (referral from rheumatologist/infectious logists/general practitioner) > Letter with findings to referrer

Follow-up examination

• Visual acuity subjective
  • If applicable Advanced refraction
• Tensio applanatory and papillary assessment (papillary swelling, atrophy)

• Anterior eye segment
  • Conjunctiva: low irritant
  • Cornea: smooth, clear (cornea verticillata)
  • Anterior chamber: deep, irritant
  • Iris/pupil: round, playing
  • Lens: age-appropriate (subcapsular lens opacity)
• Mydriasis fundus (Tropicamide AT 3x/every 5 minutes)
  • Papilla: vital, normally excavated
  • Macula: downright structured, inconspicuous pigment pattern (no foveal reflex/pigment shifts/bull's eye maculopathy)
  • vessels: inconspicuous vascular structure
  • Retinal periphery: no fresh lesions/retinal fisses/amotions
• FAF (fundus autofluorescence): inconspicuous pigment pattern (pigment shift)/bull's eye maculopathy)
• Fundus photography (for documentation, accounting for fundus recording)
• OCT macula: normally structured, RPE downright (pigmentation shift)/bull's eye maculopathy) (only billing in case of abnormalities)
• If applicable (for retinal abnormalities): visual field glaucoma: no scotomes/failures (bilateral para/central scotoma)

Procedural

Annual follow-up checks

• Chloroquine intake
• Hydroxychloroquine for:
  • > 5mg/kgkg/day
  • reduced kidney function (eGFR <50ml/min/1.73m²)
  • concomitant use of Tamofixen

after 5 years of treatment > annual check-ups until further notice

In the case of drug-induced toxicity: consultation with the attending physician regarding changes in therapy (after discontinuation: new damage may still occur and old damage may progress)

> Referral to tertiary clinic for co-assessment and, if applicable, MFerG

Other drug-associated retinopathies/neuropathies

canthaxanthin (tanning tablets)

Test as with chloroquine
fundus: Ring-shaped deposits in the superficial retina

Prognosis: Good, usually complete recovery after discontinuation

Tamoxifen (Oncology)

Test as with chloroquine
Fundus: Crystal-like deposits of the inner retina
OCT M P & Photo: Macular Edema > Discontinue medication

Procedure: Control only in case of symptoms (visual acuity reduction)

Prognosis: Good, possible improvement in vision, crystals persist after discontinuation

Ethambutol/myambutol (tuberculosis)

Test as with chloroquine plus in addition:
Ishihara color vision test: reduced color vision
visual field: bilateral central/centrocecal scotoma, possibly bitemporal defects)
Fundus in mydriasis: bleeding
OCT M P and photo: atrophy (papilledema, atrophy)

Follow-up checks:
Every 4 months (dose >15mg/kgkg/day)
Every 6 months (dose <15mg/kgkg/day)

Gilenya (fingolimod, immunosuppressant) (multiple sclerosis)

Test as with chloroquine
Baseline examination before starting treatment
OCT M P & photo: macular edema

Procedural checks:
3, 6, 12 months after the start of therapy, then only if there is a loss of vision

Other medications with potential ocular side effects

lithium

Pseudotumor cerebri/stulation papilla
Downbeat nystagmus

Tysabri (natalizumb) (immunosuppressant)

Leukencephalopathy in the visual tract > Visual field absences
visual field

aminoclycosides (gentamycin, tobramycin, amikacin intravireal injection)

Fundus: ischemia, retinal hemorrhages, pigment shifts, optic atrophy

thioridazine

Front eye sections: pigment deposits in eyelids, cornea, lens
fundus: peripheral retinal pigment shifts
Ishihara: color vision disorder

Orkambi (lumaceftor+ivacaftor) (cystic fibrosis)

Front eye sections: cataract (cave: amblyopia in children)