[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Ophthalmology](https://durgical.com/en/ophthalmology/) › [Ophthalmic drugs and toxicity](https://durgical.com/en/ophthalmology/areas/drugs/) › Systemic drugs that harm the eye # Systemic drugs that harm the eye - Drugs and toxicity Many common drugs affect the eye, from harmless corneal deposits to blindness. Knowing which ones guides screening and questions. Updated Nov 5, 2026 **See it in 3D:** [Lens](https://durgical.com/en/anatomy/lens/) · [Macula](https://durgical.com/en/anatomy/macula/) · [Optic nerve](https://durgical.com/en/anatomy/optic-nerve/) · [Cornea](https://durgical.com/en/anatomy/cornea/) ## Key points - Steroids: cataract and glaucoma. - Hydroxychloroquine: maculopathy; ethambutol: optic neuropathy. - Topiramate: bilateral angle closure. - Tamsulosin: floppy iris. ## What it is Many systemic drugs reach the eye. Some effects are harmless and expected; others are sight-threatening and need screening or a change of drug. The general doctor prescribes most of these drugs and is often the first to hear the symptoms, so knowing the main associations is part of safe prescribing. ## What to know - Corticosteroids: cataract and glaucoma. - Hydroxychloroquine and chloroquine: retinal toxicity (bull's-eye maculopathy). - Ethambutol and linezolid: optic neuropathy. - Topiramate and other sulfa drugs: bilateral acute angle closure and a myopic shift. - Tamsulosin: floppy iris during cataract surgery. - Vigabatrin: permanent constriction of the visual field. ## Systemic drugs and their eye effects | Drug | Eye effect | What to do | | --- | --- | --- | | [Corticosteroids](https://durgical.com/en/conditions/cataract/) | Cataract, raised eye pressure | Periodic pressure and lens checks | | Hydroxychloroquine | Maculopathy | Baseline exam and yearly screening after 5 years | | [Ethambutol](https://durgical.com/en/conditions/tuberculosis/) | Optic neuropathy | Acuity and colour vision checks; stop if they fall | | Amiodarone | Corneal deposits (harmless); rarely optic neuropathy | Ask about visual loss | | [Topiramate](https://durgical.com/en/conditions/acute-angle-closure-glaucoma/) | Bilateral angle closure, myopic shift | Stop the drug; emergency if painful | | [Tamsulosin](https://durgical.com/en/conditions/cataract/) | Floppy iris during cataract surgery | Tell the eye surgeon | | [Isotretinoin](https://durgical.com/en/conditions/dry-eye-disease/) | Dry eye, reduced night vision | Lubricants; caution with contact lenses | | Vigabatrin | Visual field constriction | Field monitoring | ## Toxicity and risks - Anticholinergic and sympathomimetic drugs (antihistamines, antidepressants, decongestants, nebulised bronchodilators) can trigger angle closure in eyes with narrow angles. - Digoxin toxicity can cause yellow vision; phosphodiesterase inhibitors can tint vision blue. - Some drug effects persist or progress after stopping, which is why baseline exams matter. ## Next step / Initial management - Before starting hydroxychloroquine, ethambutol or vigabatrin: baseline eye assessment. - New visual symptoms on any of these drugs: ophthalmology, and consider stopping the drug with the prescriber. - Painful red eye with halos after starting topiramate: emergency (angle closure). - Tell patients on tamsulosin to mention it before cataract surgery. ## Test yourself Think of the answer, then tap the question to see it. ## Which antiepileptic can cause bilateral acute angle closure? Topiramate, through swelling of the ciliary body. ## Why should a patient tell the eye surgeon about tamsulosin? Because it causes a floppy iris during cataract surgery, which the surgeon must plan for. ## Which drug causes permanent visual field constriction? Vigabatrin. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/ophthalmology/systemic-drugs-that-harm-the-eye/) ## Connections ## See it in 3D 4 The structures of Durgical's 3D anatomy where it is found. - [Lens](https://durgical.com/en/anatomy/lens/) - [Macula](https://durgical.com/en/anatomy/macula/) - [Optic nerve](https://durgical.com/en/anatomy/optic-nerve/) - [Cornea](https://durgical.com/en/anatomy/cornea/) ## Related 5 - [Hydroxychloroquine: retinal screening](https://durgical.com/en/ophthalmology/hydroxychloroquine-retinal-screening/) - [Ethambutol and the optic nerve](https://durgical.com/en/ophthalmology/ethambutol-and-the-optic-nerve/) - [Steroid eye drops: glaucoma, cataract and infection](https://durgical.com/en/ophthalmology/steroid-eye-drops-glaucoma-cataract-and-infection/) - [Acute angle closure: what to do before the ophthalmologist](https://durgical.com/en/ophthalmology/acute-angle-closure-what-to-do-before-the-ophthalmologist/) - [Colour vision testing](https://durgical.com/en/ophthalmology/colour-vision-testing/) ## Related conditions 4 - [Cataract](https://durgical.com/en/conditions/cataract/) - [Open-angle glaucoma](https://durgical.com/en/conditions/open-angle-glaucoma/) - [Acute angle-closure glaucoma](https://durgical.com/en/conditions/acute-angle-closure-glaucoma/) - [Dry eye disease](https://durgical.com/en/conditions/dry-eye-disease/) ## In Pharmacology 9 - [Hydroxychloroquine](https://durgical.com/en/pharmacology/hydroxychloroquine/) - [Ethambutol](https://durgical.com/en/pharmacology/ethambutol/) - [Amiodarone](https://durgical.com/en/pharmacology/amiodarone/) - [Topiramate](https://durgical.com/en/pharmacology/topiramate/) - [Tamsulosin](https://durgical.com/en/pharmacology/tamsulosin/) - [Isotretinoin](https://durgical.com/en/pharmacology/isotretinoin/) - [Vigabatrin](https://durgical.com/en/pharmacology/vigabatrin/) - [Linezolid](https://durgical.com/en/pharmacology/linezolid/) - [Digoxin](https://durgical.com/en/pharmacology/digoxin/) [← All of ophthalmology](https://durgical.com/en/ophthalmology/) Educational content; not a clinical guideline and no substitute for assessment by a health professional. For sudden visual loss, severe eye pain, a chemical burn or an eye injury, go to an emergency department at once. Sources: [Chloroquine and Hydroxychloroquine Toxicity](https://www.ncbi.nlm.nih.gov/books/NBK537086/) (StatPearls Publishing (NCBI Bookshelf), 2024); [Ethambutol](https://www.ncbi.nlm.nih.gov/books/NBK559050/) (StatPearls Publishing (NCBI Bookshelf), 2024); [Amiodarone](https://www.ncbi.nlm.nih.gov/books/NBK482154/) (StatPearls Publishing (NCBI Bookshelf), 2023); [Vigabatrin](https://www.ncbi.nlm.nih.gov/books/NBK557579/) (StatPearls Publishing (NCBI Bookshelf), 2024); [Steroid-Induced Glaucoma](https://www.ncbi.nlm.nih.gov/books/NBK430903/) (StatPearls Publishing (NCBI Bookshelf), 2026). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/ophthalmology/systemic-drugs-that-harm-the-eye/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/ophthalmology/systemic-drugs-that-harm-the-eye/