• Steroids
• Desferrioxamine
• Hydroxychloroquine 
• Ethambutol
• tamoxifen; vigabatrim not yet covered
• see paper, Nencini,
• electodiagnostics, Dr Peter Good
  

Steroid tablets are well known to be a cause of chronic glaucoma (high pressure in the eye).

• patients prescribed systemic steroids should have their eye pressure measured after the first month, six months, and every year after that. If the dose is less than 10mg prednisolone/day then toxic effects are unlikely.
• Indeed, even at high doses 30-60mg a day, glaucoma is unlikely but it does occur.
• There is a genetic component..most people will not develop glaucoma.
• Steroids also cause cataracts, in a dose related manner. This affects most patients.
• Rarely steroids may contribute to CSR.
• See

Steroid creams used around the face, and nasal steroids, may also cause glaucoma.

• Steroids creams should ideally not be used near the eyes, but if they are used, low strengths should be used, and the eyes should be checked for glaucoma as above.
• nasal sprays

Desferrioxamine may cause retinal toxicity

• EOG;  
• desferrioxamine study group
• children
• Lu
• google
• review

• Hydroxychloroquine  excellent review
• Foveal change (Pasadhika 2010)
• Age and dose Bergholz 2010
• Investigations Xiaoyun 2010
• important paper BJO 2011

This study reported:

• 16 patients, all women, had on average 13y of hydroxychloroquine
• lLean body weight of 3 were below 6.5mg/kg
• 10 had difficult reading, rest had no symptoms
• findings ranged from normal appearance (3) to mild RPE changes to Bulls eye maculopathy
• all had macular cone dysfunction on electrodiagnostic testing
• concerning visual fields,
  • 15 patients visual field defects
  • visual field defects continued after stopping drug
• the fields:
  • isolated central loss (n=10)
  • generalized constriction including central loss (n=3)
  • superior peripheral VF constriction and central loss (n=1)
  • paracentral loss (n=1)
• Visual acuity ranged from 20/20 OU to hand motion.
• Four patients in the series were younger than 60 and only 1 patient had been taking medication less than 5 years (although she had been taking a very high daily dosage)
• this suggests that unless high-risk features are present, regular ophthalmologic assessment may not be warranted before 5 years

Lean body weight should be used to calculate dose:

Lean body weight for women was calculated as follows:
(1.07 x weight) − 148x(weight squared/ [100 x height {in meters
squared}]).
Body mass index was calculated as weight in kilograms
divided by height in meters squared.

• google
• Not reversible...use VEP
• ERG