Bull's eye maculopathy is associated with which drugs?

• A. Chloroquine
• B. Thioridazine
• C. Chlorpromazine
• D. All of the above

Answer: (D)

Bull's eye maculopathy is a pattern of drug-induced retinal toxicity indicating damage to the retinal pigment epithelium and surrounding photoreceptors around the fovea, producing a circular ring around a relatively preserved center. Chloroquine and hydroxychloroquine are classic culprits; with long-term or high-dose use, these drugs accumulate in the RPE and outer retina, leading to parafoveal cell loss and the characteristic bull's-eye appearance on examination and imaging. The risk rises with higher dose, longer duration, kidney function issues, and existing retinal changes.

Thioridazine, a phenothiazine antipsychotic, is well known for causing pigmentary retinopathy and can present with a bull's-eye maculopathy pattern, especially at higher cumulative doses. Chlorpromazine, another phenothiazine, can also cause retinal pigment changes, and although less common, bull's-eye configurations have been reported.

Since all of these drugs can be associated with bull's eye maculopathy, all of the above is the best answer.