Why is hydroxychloroquine (Plaquenil) important in ophthalmic history?

Hydroxychloroquine can cause irreversible retinal toxicity (bull's-eye maculopathy) with prolonged use. The risk increases with cumulative dose and duration beyond 5 years. Patients on hydroxychloroquine require annual retinal screening with OCT and visual field testing to detect early toxicity before irreversible damage occurs.

Why does tamsulosin matter before cataract surgery?

Tamsulosin and other alpha-blocker medications cause intraoperative floppy iris syndrome (IFIS) during cataract surgery, where the iris billows, constricts, and prolapses through surgical incisions. IFIS risk persists even after discontinuing the medication. The surgeon needs this information to prepare appropriate surgical strategies.

What supplements should be documented in ophthalmic history?

Document AREDS2 formula supplements (vitamins C, E, zinc, lutein, zeaxanthin) which indicate AMD risk or diagnosis, omega-3 fatty acids often taken for dry eye, and any other eye health supplements. These reveal the patient's known risk factors and current self-management strategies.

Medication and Supplement History: Ocular Side Effects and Drug Interactions

Why Medication History Matters in Eye Care

Many systemic medications produce ocular side effects that can mimic, worsen, or cause eye disease. Additionally, knowing what medications a patient takes reveals their underlying medical conditions, even if the patient forgets to mention them. A complete medication and supplement history protects patient safety and helps the ophthalmologist interpret clinical findings in the proper context.

Documenting Medications

For each medication, document:

Drug name: Both brand and generic when possible
Dosage: Strength and amount per dose
Frequency: How often the patient takes it
Route: Oral, topical, injectable, inhaled
Duration: How long they have been taking it
Prescribing physician: Helpful for coordination of care

Include all categories: prescription medications, over-the-counter drugs, eye drops, and herbal supplements. Patients often forget to mention OTC medications or drops, so ask specifically.

Medications with Significant Ocular Effects

Medication	Ocular Side Effect
Corticosteroids (oral/topical)	Elevated IOP, posterior subcapsular cataracts
Hydroxychloroquine (Plaquenil)	Bull's-eye maculopathy, retinal toxicity
Tamsulosin (Flomax)	Intraoperative floppy iris syndrome (IFIS)
Amiodarone	Corneal verticillata (whorl deposits)
Topiramate	Acute angle closure, myopic shift
Isotretinoin (Accutane)	Severe dry eye, corneal opacities
Anticholinergics	Pupil dilation, accommodation difficulty, angle narrowing
Blood thinners (warfarin)	Subconjunctival hemorrhage, increased surgical bleeding risk

Tamsulosin (Flomax) and other alpha-blockers are critical to identify before cataract surgery because they cause intraoperative floppy iris syndrome (IFIS). Even if the patient stopped taking the medication years ago, IFIS risk persists. Always ask about current and past alpha-blocker use.

Ocular Supplements

Many patients take nutritional supplements for eye health. Document these as well:

AREDS2 formula: Vitamins C, E, zinc, copper, lutein, and zeaxanthin for age-related macular degeneration
Lutein and zeaxanthin: Macular pigment supplements
Omega-3 fatty acids: Often recommended for dry eye
Bilberry extract: Marketed for general eye health

Knowing what supplements a patient takes reveals what conditions they are concerned about or have been told they are at risk for, providing additional clinical context.

Over-the-Counter Medications

Patients frequently use OTC products that affect the eyes:

Antihistamines (diphenhydramine, cetirizine): Can cause dry eyes and pupil dilation
Decongestants: May increase intraocular pressure in susceptible individuals
NSAIDs (ibuprofen, aspirin): Increase bleeding risk during ocular procedures
Artificial tears: Document brand and frequency to assess dry eye management

Not asking specifically about eye drops when documenting medication history. Many patients do not consider eye drops to be "medications" and will not mention them unless directly asked. Always include "Are you using any eye drops, including artificial tears?" in your interview.

Ask patients to bring their medication bottles (or a photo of them) to appointments. This ensures accurate drug names, dosages, and manufacturers rather than relying on the patient's memory. Some practices provide pre-visit instructions requesting this.

Key Takeaways

Document all medications including prescription, OTC, eye drops, and supplements with name, dose, frequency, route, and duration
Corticosteroids can cause elevated IOP and cataracts; hydroxychloroquine can cause retinal toxicity
Tamsulosin (alpha-blockers) must be documented before cataract surgery due to IFIS risk
Ocular supplements (AREDS2, lutein, omega-3) reveal the patient's known risk factors
Always ask specifically about eye drops, as patients often omit them
Encourage patients to bring medication bottles or photos to appointments