Features
Talc (magnesium silicate) serves as a common vehicle for many intravenous medications used for recreational use such as heroin, codeine, meperidine, pentazocine, methadone, and methylphenidate hydrochloride (Ritalin). Intravenous injection of talc embolizes to the lung, leading to pulmonary hypertension. Eventually, this leads to the development of collateral vessels, which allows the talc to enter into the systemic circulation.
89.1.1 Common Symptoms
Blurry vision, floaters, asymptomatic.
89.1.2 Exam Findings
Glistening yellow crystals in the small arterioles of the posterior pole; talc emboli possible in the nerve fiber layer capillaries and choriocapillaris; microaneurysmal dots and venous loops have been reported.
89.2 Key Diagnostic Tests and Findings
89.2.1 Optical Coherence Tomography
Multiple hyperreflective dots and thinning of the inner retinal layers (▶ Fig. 89.1).
Fig. 89.1 Talc retinopathy. (a) Red free and (b) color fundus photograph demonstrate punctate crystals/dots in the macula in a patient with history of cocaine use and intravenous methylphenidate hydrochloride (Ritalin) use. (c) Optical coherence tomography confirms localization of punctate dots to the inner retina. (Images courtesy of Pouya Dayani.)
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