A 29-year-old man with a 3-year history of paranoid schizophrenia and hypothyroidism presented with bilateral eye pain on upgaze as shown below. According to his partner, each episode lasts 20-40 minutes and the patient remains conscious. Upon examination, the patient also has impaired downgaze. The ophthalmologist determines that this patient’s condition is likely due to a drug reaction.
Which two classes of drugs are most commonly implicated in this patient’s condition?
A. Thyroid hormones and anti-emetics
B. Radioactive iodine and neuroleptics
C. Antiemetics and anticholinergics
D. Neuroleptics and antiemetics
Correct: D
The patient presents with an oculogyric crisis, which is tonic upward deviation of the eyes with impaired downgaze. The most implicated drugs in oculogyric crises are neuroleptics (specifically haloperidol) and antiemetics (metoclopramide), making option D the correct answer. Thyroid hormones (option A) and radioactive iodine (option B) have not been reported to cause oculogyric crisis. Hyperthyroidism may be associated with exophthalmos and lid retraction, which are not seen in this patient. Anticholinergics (option C) are used as a treatment for oculogyric crisis and are not a cause.