The effect of systemic and topical ophthalmic medications on choroidal thickness: A review

Abstract

The choroid plays an important role in various ocular pathologies and retinal blood supply. There is a knowledge gap on how the choroid is affected by systemic and topical medications. Systemic medications that affect microvasculature elsewhere in the body can also affect the microvasculature of the choroid. This review summarizes current knowledge on associations between systemic and topical medications and changes in choroidal thickness (CT). This review included 71 studies on mydriatics/cycloplegics, intraocular pressure (IOP)‐lowering therapies, antihypertensives, adrenergic antagonists, statins, corticosteroids, hydroxychloroquine, isotretinoin, hormonal contraceptives, phosphodiesterase inhibitors, antipsychotics, antineoplastic agents, ethanol, caffeine and nicotine. IOP‐lowering therapies, atropine eye drops, and systemic administration of β blockers and ethanol are associated with a significant increase in CT. Cyclopentolate and phenylephrine are associated with a CT reduction. Systemic medications that decrease CT include caffeine and nicotine. Tropicamide, angiotensin‐converting enzyme inhibitors, angiotensin receptor blockers, statins, corticosteroids, hydroxychloroquine and hormonal contraceptives have mixed findings. CT increase associated with IOP‐lowering therapies is possibly achieved by enhancing aqueous humour flow to the choroid thus elevating choroidal blood flow and thickness. CT changes appear to be independent from systemic blood pressure changes, suggesting that a significant association with an antihypertensive could be due to an idiosyncratic drug property. Statins and candesartan decrease macrophage accumulation and intercellular adhesion molecule 1 expression in the choroid. The choroid and its response to various disease processes and systemic medication can be further investigated to improve patient care, particularly in patients with choroid and retina pathologies.

Pachychoroid Spectrum Disorders: An Updated Review

“…[ 117 ] CSCR eyes have a significant decrease in accommodative ability, which may be linked to a decreased parasympathetic activity in affected eyes. [ 117 ] Similarly, pilocarpine, a topical cholinergic, causes choroidal thinning in healthy eyes, [ 118 ] while topical atropine, a parasympathetic inhibitor, significantly increases choroidal thickness, [ 119 ] providing some support for the hypothesis that sympathetic-parasympathetic dysregulation may lead to a pachychoroid predisposition. [ 117 ]…”

Analysis of choroidal thickness in juvenile systemic lupus erythematosus and its correlation with laboratory tests

“…HCQ also inhibits the production of reactive oxygen species and inflammatory cytokines, which may also contribute to increased CT in its early use. With the gradual accumulation of long-term use, HCQ probably causes retino-choroidal toxicity and leads to decreased CT [ 20 , 42 , 43 ]. The effect of HCQ treatment with or without retinopathy on CT needs to be further investigated.…”

Central serous chorioretinopathy: Pathophysiology, systemic associations, and a novel etiological classification

“…[ 6 ] The normative value of choroidal thickness is subjected to physiological factors that may be either predetermined such as the axial length or subjected to physiological (diurnal) influences, pharmacological influences, and disease states such as end-stage renal disease. [ 6 7 8 9 10 11 ] In a recent review, Yeung et al . report a significant increase in choroidal thickness after intraocular pressure lowering therapies, atropine eye drops, and systemic administration of β-blockers and ethanol, while cyclopentolate, phenylephrine, caffeine, and nicotine are associated with reduced thickness.…”

“…report a significant increase in choroidal thickness after intraocular pressure lowering therapies, atropine eye drops, and systemic administration of β-blockers and ethanol, while cyclopentolate, phenylephrine, caffeine, and nicotine are associated with reduced thickness. [ 10 ] Phenylephrine and sympathomimetics have also been linked with CSC,[ 12 13 14 ] and animal models of adrenaline-induced CSC support these observations. [ 15 16 ] Altered ChBF is a frequent mechanism that leads to increased hydrostatic pressure and increased capillary permeability.…”