Drug-induced cataract: Comprehensive review of implicated agents and underlying pathophysiological mechanisms

Background: Drug-induced cataract is an increasingly recognized cause of secondary lens opacification. While corticosteroids remain the most established cause, recent pharmacovigilance data have identified numerous additional agents.

Objective: To provide a comprehensive and updated review of pharmacological agents associated with cataract formation and to analyze their underlying mechanisms.

Methods: A narrative review of the literature was conducted using PubMed, Google Scholar, and Elsevier databases, prioritizing recent studies (2020–2026), pharmacovigilance analyses, and mechanistic research.

Results: Over 60 drugs have been significantly associated with cataract formation in recent large-scale analyses. Beyond corticosteroids, emerging signals involve anticancer therapies, ophthalmic agents such as omidenepag isopropyl, central nervous system drugs like clobazam, and metabolic agents such as nitisinone. Mechanisms include oxidative stress, protein aggregation, ionic imbalance, and cytoskeletal disruption.

Conclusion: Drug-induced cataract is a multifactorial and evolving entity. Awareness of both established and emerging causative agents is essential for prevention, early detection, and optimal patient management.