NBEO Part II Treatment and Management of Ocular Disease (TMOD) Practice Test

Blue scleral pigmentation from drug exposure is the concept here. Minocycline, especially with long-term use, can deposit pigment in the sclera and surrounding tissues, producing a blue‑gray discoloration that is usually bilateral and cosmetic. This pigment accumulation occurs as the drug or its metabolites are taken up by scleral tissues and macrophages, settling in the scleral stroma. It’s a distinct ocular finding from other drug effects. Steroids and prednisone don’t typically cause blue sclera, and amiodarone more commonly leads to corneal verticillata and other anterior segment changes rather than scleral blueing. So among the options, minocycline best explains blue scleral discoloration.