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Patients maintained on phenothiazines for many years carry a high risk of developing ocular side effects - almost 100 per cent in one reported case series. The most frequent manifestation is blurred vision. This is thought to result mainly from anticholinergic effects including reduced accommodation. Increased intraocular pressure may also develop, with risk of glaucoma.
Among the more commonly used phenothiazines, prolonged chlorpromazine use is associated with pigment deposition in the eyelids, cornea and lens. Pigmented retinopathy occurs less often anterior and posterior subcapsular cataract have also been described. Retinal pigmentary changes are more often observed with thioridazine use. This effect is dose-related, and usually develops after several years of use. Effects can also occur within months with high dose therapy.
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