Question:medium
A patient diagnosed with rheumatoid arthritis was on long-term medication. After 2 years, he developed blurring of vision and was found to have corneal opacity. Which drug is most likely to cause this?
A patient diagnosed with rheumatoid arthritis was on long-term medication. After 2 years, he developed blurring of vision and was found to have corneal opacity. Which drug is most likely to cause this?
Show Hint
Think of the antimalarial DMARD that deposits in the cornea and retina over time.
Updated On: Jun 23, 2026
- Sulfasalazine
- Chloroquine
- Methotrexate
- Leflunomide
Show Solution
The Correct Option is B
Solution and Explanation
Clinical pearl: in any rheumatology patient who turns up with eye complaints, the drug you blame first is the antimalarial.
Eliminate the options. Sulfasalazine is a gut and fertility problem, not an eye one. Methotrexate hits the liver and bone marrow. Leflunomide hits the liver and blood pressure. That leaves chloroquine, the only drug here with a famous eye signature.
Chloroquine and hydroxychloroquine have a strong affinity for melanin, so they accumulate in pigmented ocular tissues. The cornea shows whorl-like deposits (vortex keratopathy) that produce haloes and blurring, while the macula develops the classic bull's-eye maculopathy. Because the patient describes corneal opacity plus blurred vision after 2 years of therapy, chloroquine fits perfectly. This is why guidelines mandate baseline and periodic ophthalmic screening for anyone on these drugs.
Ref: KD Tripathi, Essentials of Medical Pharmacology, 8e.
Eliminate the options. Sulfasalazine is a gut and fertility problem, not an eye one. Methotrexate hits the liver and bone marrow. Leflunomide hits the liver and blood pressure. That leaves chloroquine, the only drug here with a famous eye signature.
Chloroquine and hydroxychloroquine have a strong affinity for melanin, so they accumulate in pigmented ocular tissues. The cornea shows whorl-like deposits (vortex keratopathy) that produce haloes and blurring, while the macula develops the classic bull's-eye maculopathy. Because the patient describes corneal opacity plus blurred vision after 2 years of therapy, chloroquine fits perfectly. This is why guidelines mandate baseline and periodic ophthalmic screening for anyone on these drugs.
Ref: KD Tripathi, Essentials of Medical Pharmacology, 8e.
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