What drugs make cataracts worse?: A guide to medication risks

October 7, 2025 •

4 min read

Long-term corticosteroid use is a widely recognized risk factor for developing cataracts, particularly posterior subcapsular cataracts. This highlights the importance of understanding what drugs make cataracts worse and how to manage these risks safely with your doctor.

Quick Summary

Several medications, including corticosteroids, statins, and some antidepressants, have been linked to an increased risk of developing or worsening cataracts, particularly with long-term use.

Key Points

Corticosteroids: Chronic use of steroids, especially oral and inhaled forms, is a well-established cause of posterior subcapsular cataracts.
Statins: Research on statin medications for cholesterol and cataract risk is inconsistent, but some studies show a potential link, particularly with long-term use.
Antidepressants: Certain classes of antidepressants, including SSRIs, SNRIs, and TCAs, have been associated with a slightly elevated risk of cataract development.
Antipsychotics: Older phenothiazine-based antipsychotics, such as chlorpromazine, have been linked to potential lens opacities and other vision issues.
Hydroxychloroquine: This antimalarial drug requires regular eye monitoring due to its link with retinal toxicity and potential, though less common, cataract risk.
Consult Your Doctor: Never stop or change medication dosage without consulting your prescribing physician, as the benefits often outweigh the potential eye health risks.

A toxic cataract is a drug-induced cataract that develops as a side effect of exposure to certain medications. While aging is the most common cause, several drugs are known to cause or accelerate lens clouding. The risk is often associated with high doses and long-term use. If you have been diagnosed with cataracts or are at high risk, it is important to be aware of the medications that could influence their progression.

Understanding drug-induced cataracts

Drug-induced cataracts form when substances alter the delicate balance of the eye's lens, leading to protein aggregation and clouding. The severity and type of cataract can vary depending on the medication, dosage, duration, and individual susceptibility. In most cases, the benefits of the medication far outweigh the risks, but it is essential to have open communication with your healthcare provider about any vision concerns.

Medications with established cataract risks

Corticosteroids (steroids)

Corticosteroids are among the most recognized and studied drugs linked to cataract formation, especially posterior subcapsular cataracts, which form at the back of the lens. They are prescribed for a wide range of inflammatory and autoimmune conditions, including asthma, lupus, arthritis, and eczema.

Oral and inhaled corticosteroids: Chronic, high-dose use of oral and inhaled steroids (e.g., prednisone, dexamethasone) significantly increases cataract risk.
Topical corticosteroids: Steroid eye drops and creams applied near the eyes can also elevate risk, especially with prolonged use.

Antipsychotics and phenothiazines

Certain older antipsychotic medications, particularly those in the phenothiazine class like chlorpromazine, have been linked to eye-related side effects, including corneal deposits and lens opacities. High doses and long-term treatment are typically associated with this risk.

Antimalarial drugs (hydroxychloroquine)

Hydroxychloroquine, commonly used for conditions like lupus and rheumatoid arthritis, is known to cause retinal toxicity with long-term use. While less common, cataracts and other vision problems have also been reported, necessitating regular eye examinations for patients on these drugs.

Medications with possible or inconsistent links to cataract risk

Statins (cholesterol-lowering drugs)

Research on the link between statins and cataracts is mixed and controversial.

Evidence for an association: Some observational studies and genetic analyses have suggested a link between statin use and an increased risk of cataracts. The proposed mechanism involves statins' impact on cholesterol synthesis, which is crucial for lens cell health.
Evidence against an association: Other large-scale reviews and meta-analyses have found no definitive association between statin use and cataract formation. The benefits of statins in preventing cardiovascular disease are widely accepted and should be considered alongside any potential risk.

Antidepressants

A meta-analysis of studies has suggested a small, but significant, association between antidepressant use and an increased risk of cataracts, specifically with tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs). The mechanism may involve elevated serotonin levels affecting the aqueous humor.

Diuretics (thiazides)

Some long-term studies have noted a possible link between thiazide diuretics, used for high blood pressure, and an increased risk of cataracts. This might be related to changes in fluid and electrolyte balance in the eye. However, the increased risk is generally considered small compared to the cardiovascular benefits.

Comparison of major drug-induced cataract risks


Drug Class	Example Drugs	Common Type of Cataract	Primary Risk Factor	Note on Evidence
Corticosteroids	Prednisone, Dexamethasone	Posterior subcapsular	Long-term, high-dose use	Well-established risk
Statins	Atorvastatin, Rosuvastatin	Variable, potentially nuclear/cortical	Long-term use	Inconsistent evidence; some studies show a link
Phenothiazine Antipsychotics	Chlorpromazine	Lens opacities	Long-term, high-dose use	Established link, particularly for older drugs
Antidepressants (SSRIs, TCAs)	Fluoxetine, Amitriptyline	Variable	Long-term use	Some evidence of a slight increase in risk
Antimalarials	Hydroxychloroquine	Variable, also retinal toxicity	Long-term use	Established retinal risk; lower cataract risk

Managing medication risks for cataract patients

Communicating with your doctor

Create a medication list: Keep an up-to-date record of all prescriptions, over-the-counter drugs, and supplements you take. Share this list with your ophthalmologist and primary care physician.
Discuss concerns openly: If you have cataracts or are experiencing vision changes, ask your doctor if any of your medications could be contributing. They can help you weigh the risks and benefits.
Explore alternatives: In some cases, a doctor may be able to switch you to a different medication with a lower risk profile. However, this is only an option if a suitable alternative exists and is medically appropriate.

Special considerations for cataract surgery

Patients preparing for cataract surgery must be particularly careful about their medication use, as some drugs can interfere with the procedure.

Blood thinners: Medications like aspirin, clopidogrel, and warfarin may need to be stopped temporarily before surgery, as they increase the risk of bleeding.
Alpha-blockers: Drugs used for prostate or bladder issues, such as tamsulosin (Flomax), can cause a complication during surgery called Intraoperative Floppy Iris Syndrome (IFIS). It's critical to inform your surgeon if you currently take or have ever taken these medications.

Conclusion: Balancing treatment and eye health

While several medications, especially corticosteroids, have been linked to cataract formation or worsening, it's crucial to remember that this does not mean you should stop your treatment. In most cases, the medical condition being treated poses a far greater risk to your overall health. The goal is not to eliminate medication but to manage risk collaboratively with your medical team. Open communication, regular eye monitoring, and understanding the potential side effects of your medications are the best ways to protect your vision while maintaining your overall health. For more information, the National Institutes of Health provides research and insights on drug-associated cataract formation.

Frequently Asked Questions

Long-term use of any form of corticosteroid (oral, inhaled, topical) is a known risk factor, but the risk is most significant with chronic, high-dose systemic and inhaled use. Short-term use generally poses a much lower risk.

No. The link between statins and cataracts is not definitive, and the cardiovascular benefits of statins usually far outweigh the potential eye risks. Consult your doctor before making any changes.

The exact mechanism is unclear but is thought to involve gene transcription changes in lens epithelial cells, leading to protein aggregation and the formation of posterior subcapsular cataracts.

No. Once the lens proteins have clumped together, the cataract is permanent and requires surgical removal. Discontinuing the medication may prevent further progression.

Inform your surgeon of all medications you are taking, especially blood thinners, insulin, and alpha-blockers like tamsulosin (Flomax), as they can affect the procedure.

Having pre-existing conditions like diabetes, glaucoma, or high blood pressure can increase the risk of cataracts, and the medications for these conditions may also play a role.

Studies show inconsistent links between long-term NSAID use and cataracts, and the association is considered weak compared to other medications like corticosteroids.

IFIS is a complication during cataract surgery where the iris becomes floppy and billows, making surgery more difficult. It is associated with tamsulosin (Flomax) and other alpha-blockers, and can occur even years after stopping the medication.