Antipsychotic-Induced Ocular Changes: Risk Assessment and Management

Ocular Toxicity Risks and Management

• The American Academy of Pediatrics recommends that antipsychotics with minimal ocular toxicity profiles, such as aripiprazole, be prioritized for patients with pre-existing ocular disease or high ocular risk 1, 2
• The risk of ocular toxicity with antipsychotics can be mitigated by maintaining doses at the minimum effective level, avoiding polypharmacy, and considering pharmacogenetic testing (CYP2D6) to optimize dosing and reduce toxicity risk 3, 4
• Patients on chlorpromazine must implement strict photoprotection measures, including avoiding undue sun exposure, wearing UV-protective eyewear, and applying sunscreen to periocular skin 3
• The American Academy of Pediatrics suggests that alternative antipsychotics with lower ocular toxicity profiles, such as risperidone, be considered for patients who experience ocular toxicity with other agents 1, 2
• The National Institute of Mental Health recommends that patients with psychiatric conditions be proactively screened for visual symptoms, rather than relying on symptom-driven evaluation, to prevent delayed recognition of ocular toxicity 5