Question:
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?
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Think of the antimalarial DMARD that deposits in the cornea and retina over time.
Updated On: Jun 23, 2026
- Sulfasalazine
- Chloroquine
- Methotrexate
- Leflunomide
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The Correct Option is B
Solution and Explanation
Answer: Chloroquine.
Step 1: Chloroquine and hydroxychloroquine are disease-modifying antirheumatic drugs used in rheumatoid arthritis, SLE, discoid lupus and sarcoidosis.
Step 2: Their hallmark long-term toxicity is ocular. The drug binds melanin and concentrates in the cornea and retina. This gives corneal deposits (vortex keratopathy / corneal opacity causing haloes and blurred vision) and the dreaded bull's-eye retinopathy.
Step 3: Why not the others. Sulfasalazine mainly causes GI upset and reversible oligospermia. Methotrexate causes hepatotoxicity, marrow suppression and mucositis. Leflunomide causes diarrhoea, hypertension and hepatotoxicity. None of these classically deposit in the cornea.
So a 2-year history of corneal opacity with blurred vision in a rheumatoid patient points to chloroquine.
Ref: KD Tripathi, Essentials of Medical Pharmacology, 8e.
Step 1: Chloroquine and hydroxychloroquine are disease-modifying antirheumatic drugs used in rheumatoid arthritis, SLE, discoid lupus and sarcoidosis.
Step 2: Their hallmark long-term toxicity is ocular. The drug binds melanin and concentrates in the cornea and retina. This gives corneal deposits (vortex keratopathy / corneal opacity causing haloes and blurred vision) and the dreaded bull's-eye retinopathy.
Step 3: Why not the others. Sulfasalazine mainly causes GI upset and reversible oligospermia. Methotrexate causes hepatotoxicity, marrow suppression and mucositis. Leflunomide causes diarrhoea, hypertension and hepatotoxicity. None of these classically deposit in the cornea.
So a 2-year history of corneal opacity with blurred vision in a rheumatoid patient points to chloroquine.
Ref: KD Tripathi, Essentials of Medical Pharmacology, 8e.
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