Talc retinopathy is a common eye condition in people who use injectable drugs for a long time. Talc is a filler that is found in both prescription drugs like methylphenidate and illegal drugs like heroin. Talc retinopathy is usually explained in texts as an embolic event that affects the retinal vessels and capillaries. This is strictly true, but people forget that only very small particles can get through the pulmonary capillaries and into the eye circulation. Some small capillaries might get blocked by talc particles in the blood, but particles big enough to be seen through an eye exam show a buildup of microemboli in vessel walls. 

Signs of Crystalline Retinopathy

Crystalline retinopathy doesn’t hurt most people who have it. Crystals in the retina can only be found by an eye doctor, like an optometrist or ophthalmologist, during an eye checkup. Many people may not have any signs. 

Talc retinopathy definition

Small, yellow, shiny crystals can be found inside small retinal veins and in different layers of the retina. This is a known eye disease called talc retinopathy. Ischemia and ocular vascular blockage can be linked to these crystals.

Talc retinopathy etiology

Crystalline retinopathies are a diverse group of eye diseases marked by crystal formations in any layer or area of the retina. The crystals can be made up of more than one substance, and the reasons for them can be genetic, toxic, degenerative, unknown, or caused by medical care.

Talc Retinopathy Symptoms

People who have crystalline retinopathy may notice the following signs:

• Overall loss of vision
• Problems seeing at night
• Being sensitive to light (photophobia)
• Eyelid movement that can’t be stopped

Diagnosis of Talc Retinopathy

Different testing methods have been used in the past to describe the damage to the retina in talc retinopathy. When you look at the fundus, you can generally tell these crystals apart because they have a certain look. They are found in the small retinal veins and all over the fundus. It is important to tell the difference between talc crystals and other conditions that cause crystalline retinopathy and other conditions that cause retinal bleeding. The elements that were found were put into groups based on clinical evaluation. Studies that closely look at these crystals have shown that they are usually made up of groups of several talc particles, not just one talc embolus. Because of the blood-retinal barrier, there may not be any retinal granulomas like those seen in the lungs of people who use IV drugs. On fluorescein angiography, a vascular filling flaw is seen when the embolus blocks the small blood vessels in the retina, leading to capillary non-oxygenation and ischemia in the retina. Since SD-OCT was created, it has become possible to show where these crystals are about the retinal layers. They were spread out in the inner layers of the retina, which is where the blood vessels are.

Differential Diagnosis

The main thing the particulate retinopathy does is rule out other conditions. Some of the first cases of particulate retinopathy were “talc retinopathy” cases from the early 1900s. These showed up as small, refractile bodies spread out across both eyes’ posterior poles. Crystalline or particle retinopathy can be caused by several different medical conditions. People with systemic illnesses or a history of long-term drug use or exposure to toxins can make this situation worse for themselves. Here are some ways to break down the alternative diagnoses.

Signs That Come From Systemic Etiologies

Oxalosis is when a solid salt called calcium oxalate builds up in different body parts in a bad way.  Over time, these salts can build up and lead to retinopathy, especially at the level of the retinal pigment epithelium (RPE), which makes the center of the eye darker than the surrounding area. 

Cystinosis is an uncommon lysosomal disorder that causes cysteine crystals to build up inside cells in different body parts.

A lack of the enzyme fatty aldehyde dehydrogenase can cause Sjogren-Larsson syndrome, which is a metabolic disorder. These people have crystals on both sides of their eyes in the foveal and parafoveal areas. The crystals can be of different sizes and are found in the innermost layers of the retina.

There are three types of retinal emboli: calcific emboli, cholesterol emboli, and fibrinoplatelet emboli. Brighter, bigger, and more often found close to the optic nerve are calcific emboli. People over 65 who have calcific aortic stenosis are more likely to get these kinds of emboli. People who have atherosclerotic disease have cholesterol emboli, also known as Hollenhorst plaques, that are stuck in a blood vessel and look bright and shiny.

Particulate Retinopathies Caused by Drugs

Tamoxifen is an antiestrogen drug that is not a steroid. It is used to treat breast cancer. In the nerve fiber and inner plexiform layers of the retina, you can see small, white things that can bend light.

Another use for talc is in baby powder. It can also be broken up and added to drugs to make them heavier.  People who use drugs regularly can get retinopathy, but the particles that cause this have to be smaller than the retinal blood vessels’ width (3.5 µm to 5 µm) to block them. In the early stages of talc retinopathy, cotton wool spots, and retinal hemorrhages can be seen. In later stages, small, shiny particles can be seen in large groups around the eye. The nerve fiber layer and inner nuclear layers of the eye are the parts that are impacted. These people may also have problems with their lungs and hearts because they ate these fine starch spherules for a long time and hurt them. 

Canthaxanthine is a pigment that occurs naturally. The FDA approved it as a red food coloring and as a way to treat photosensitivity. It was first sold as an over-the-counter mouth tanning agent in 1979. People who take in a lot of canthaxanthine develop retinopathy, which shows up as golden crystals in the nerve fiber layer around the fovea. These crystals don’t go away even after the drug is stopped.

Retinal neovascularization talc retinopathy

DIAGNOSIS

There are many possible causes of peripheral neovascularization, such as:

• diabetes
• sickle cell retinopathy
• hyperviscosity syndromes
• retinal embolization
• retinopathy of prematurity
• familial exudative vitreoretinopathy
• sarcoidosis
• inflammatory diseases with retinal vasculitis
• uveitis including pars planitis
• Eales’ disease
• chronic retinal detachment
• carotid-cavernous fistula
• incontinentia pigmenti.

Treatment

To treat crystalline retinopathy, it is best to get rid of the drug or agent that caused it, like the poison or medicine that caused it. For genetic diseases or situations that can’t be fixed, symptomatic treatment may be the best option.

The technique of treating peripheral neovascularization with cryotherapy and photocoagulation has been shown to be safe and successful compared to direct focal treatment of feeder veins.

Conclusion

For more than the obvious reasons doing drugs whether they are inhaled, or done intravenously is a bad idea. Not only is it addicting and can ruin your life socially, economically, and the more commonly known physical ailments but there are less common physical problems that come with doing it. One of them being vision loss or even blindness.  If you or a loved one is dealing with drug addiction get help as soon as possible and avoid the sight-threatening side effects that could come with it.

FAQ’s

What will happen if you get talc in your eyes?

Talc powder can “clog up” the retinal veins when it gets there. Because of this, the retina may die because its blood flow is cut off.

What makes talc retinopathy happen?

Talc retinopathy happens in people who have abused drugs through an IV in the past. A filler called talc is often found in pills of popular drugs like methadone, methylphenidate, and meperidine.

What’s the deal with the talc in my vitamins?

Some supplement brands may contain talc and magnesium silicate to keep the pills from caking and help them keep their shape. What’s the problem? Inhaling or eating these chemicals in some other way can make it hard to breathe and even make you sick.

If you don’t have diabetes, can you still have retinopathy?

People in their middle years or older years who don’t have diabetes often have retinopathy spots. Some eye problems that are often linked to retinopathy in people who don’t have diabetes are retinal vein occlusions, retinal telangiectasia, and retinal macroaneurysms.

Which items have talc in them?

Talc is often used in cosmetics like blush, face powder, eye makeup, and body powders because it can absorb wetness and give matte or opaque finishes. The Food and Drug Administration has a full list of all the cosmetics that have talc in them.

Food-grade sand can also be used safely to keep things from sticking together. As long as it is used in line with good industrial practice, the FDA says this form of talc is “generally recognized as safe.”

It is important to know that cosmetics and body goods do not have to be reviewed by the FDA like food does. However, they do have to be “properly labeled” and “safe under labeled or customary conditions of use.”

One of the cases against Johnson & Johnson was based on that last point. The family of one of the victims said the company didn’t tell people enough about the dangers of using the body powder in question.

Why is there a link between talcum powder and cancer?

Talc is a mineral that forms naturally and is made up of magnesium, silicon, oxygen, and hydrogen together.

Talcum powder is made by mining and grinding talc. It is often used in beauty goods. Because it naturally soaks up water, talcum powder is most often found in baby powder and face makeup, which help keep your skin dry.

Asbestos, a dangerous substance that is known to cause inflammation and lung cancer, is often found near talc in its natural state.

There is a chance that asbestos and talc will get mixed up when they are dug close to each other. Because of this pollution, talcum powder that has asbestos in it can form.

Because talcum powder with asbestos could be dangerous, the Food and Drug Administration (FDA) has played a big part in making sure that products with talc follow safe standards.