Corneal Manifestations of Chronic Systemic Drug Therapy

Yip, Vivien Cherng Hui; Sanjay, Srinivasan

doi:10.4172/2155-9570.1000128

Cited by 5 publications

(7 citation statements)

References 8 publications

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“…The phenothiazine antipsychotic chlorpromazine has been known to induce vortex-like corneal epithelial deposits 67 when administered at high doses or lower long-term doses, 3 but more typically, these deposits appear in the stroma 25,27 or endothelium. 41,43,84 Of 43 patients who had taken chlorpromazine, 4.7% had corneal epithelial manifestations described as diffuse opacification "exposed in the palpebral aperture," sometimes with a "brownish-white opacification radiating from the optic axis." 3 Corneal stromal pigment dusting (44.2%) and anterior lens capsule dusting (67.4%) were the most commonly observed ocular changes.…”

Section: Chlorpromazinementioning

confidence: 99%

“…For hydroxychloroquine, this has been shown to be 1000 g, reached in 7 years with a daily dose of 400 mg, and for chloroquine, it is 460 g, reached in 5 years with a daily dose of 250 mg. 51 For chlorpromazine, toxic retinopathy is associated with a very high dose of 2400 mg/d. 84 Optic neuropathy develops in a minority of patients (up to 2%) taking amiodarone, but because the outcome of amiodarone-associated optic neuropathy is variable and the resulting vision loss can be permanent, patients should be carefully monitored with a baseline examination and examinations at 4, 8, and 12 months after initiation of treatment. After 12 months, annual ophthalmologic visits are considered sufficient.…”

Section: Management and Counselingmentioning

confidence: 99%

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Drug-induced corneal epithelial changes

Raizman

Hamrah

Holland

et al. 2017

Survey of Ophthalmology

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Drugs across many pharmacologic classes induce corneal epithelial changes. Many of these drugs have cationic amphiphilic structures, with a hydrophobic ring and hydrophilic cationic amine side chain that allow them to cross cell membranes. These drugs lead to intracellular phospholipid accumulation, often manifested in the cornea by vortex keratopathy, with no effect on visual acuity and few ocular symptoms. Other drugs, notably antineoplastic agents, produce a fine diffuse corneal haze, sometimes accompanied by decreased vision that can be dose limiting. Still other medications cause crystalline epithelial precipitation that might require debridement for resolution. An understanding of the variety of drugs involved, the multiple mechanisms responsible, and the systemic diseases that produce similar changes can lead to improved management strategies for patients with corneal epithelial deposits. In most cases, drug therapy need not be modified or discontinued, but if visual acuity is affected, close collaboration with the prescribing physician can result in determining an optimized dose that treats systemic disease and minimizes these deposits. Additionally, close monitoring might be required if the drug is also associated with other ocular findings, such as optic neuropathy or retinopathy.

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Section: Chlorpromazinementioning

confidence: 99%

Section: Management and Counselingmentioning

confidence: 99%

Drug-induced corneal epithelial changes

Raizman

Hamrah

Holland

et al. 2017

Survey of Ophthalmology

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“…The deposits may be due to drug interaction with ultraviolet rays leading to denaturation and opacification of proteins. 3 Cataract formation is common in patients taking cumulative dose of higher than 1000 mg. 4,5 Advanced lenticular changes without any corneal involvement has not been previously reported. Both psychiatrists and ophthalmologists should be aware of these consequences to prevent and treat the ophthalmic complications promptly.…”

Section: Discussionmentioning

confidence: 89%

Anterior Segment Involvement in Antipsychotics - An Unusual Presentation

Jain¹

2018

DJO

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Anti-psychotics used for treatment of psychiatric disorders can have various ocular side effects. We hereby report a case of advanced capsular and sub-capsular lenticular opacities in a 58 year old male that was secondary to long term chlorpromazine use. The deposits persisted after discontinuation of the drug. There were however no associated deposits on the cornea. This case highlights the rare occurrence of lenticular deposits without associated corneal involvement. Periodic eye examination of patients on long term antipsychotic drugs is necessary. A timely discontinuation of the offending drug may arrest further progression.

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“…These changes are dose-dependent and are irreversible even with medication discontinuation. (2)(3)(4)(6)(7)(8)(9)(10)(11)(12)(13)(14) Changes in the anterior segment occur after a cumulative dosage of 500g, with lenticular involvement preceding corneal pigmentation. (2) Alexander and collaborators had discovered that 67% of patients who had used this medication had some alteration of the crystalline lens, while 45% of them presented corneal alteration.…”

Section: Discussionmentioning

confidence: 99%

“…It has been postulated that endothelial deposits can be attributed to the binding of chlorpromazine to dopamine D2 receptors to the corneal endothelium. (3,5,6,8,9,13,14) An experimental study showed that corneal endothelial cells are sensitive to phototoxic reactions of chlorpromazine solution pre-irradiated for 30 minutes with ultraviolet light. Because the cornea is constantly exposed to light and allows for long-wavelength ultraviolet light in, it is a potential concern that patients receiving chlorpromazine may be at risk for corneal endothelial cell damage induced by phototoxic reactions from this drug or its by-products deposited deep in stroma or endothelial cells.…”

Section: Discussionmentioning

confidence: 99%

Bilateral ocular deposit of chlorpromazine

Flügel¹,

Valle²,

Wasilewski³

2022

Revista Brasileira De Oftalmologia

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Chlorpromazine is a medication widely used in psychiatry for the treatment of psychoses, especially schizophrenia. Since 1964, published articles have been correlating this medication with the appearance of ocular alterations. In this paper, we report the case of a 65-year-old patient with ocular effects due to long-term therapy with chlorpromazine. Biomicroscopy of both eyes presented diffuse granular brown deposits, most prominent at the deep stroma and corneal endothelium level. Also showed anterior subcapsular brown deposits with a stellate pattern in the lens. The total amount exceeds 2.000g (significant for the ocular alterations described) considering the patient's daily dosage of chlorpromazine of 300mg for ten years. After performing complete ophthalmic evaluation and discarding other causes for the ocular deposits, we diagnosed a secondary corneal deposit and cataract due to the use of chlorpromazine. This case reinforces the importance of periodic follow-up with an ophthalmologist for chlorpromazine users to trace ocular changes, heeding the exposure time and its dosage.

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Corneal Manifestations of Chronic Systemic Drug Therapy

Cited by 5 publications

References 8 publications

Drug-induced corneal epithelial changes

Drug-induced corneal epithelial changes

Anterior Segment Involvement in Antipsychotics - An Unusual Presentation

Bilateral ocular deposit of chlorpromazine

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