Olanzapine-induced Cataract in a Teenage Girl

Abstract

Cataract, defined as cloudiness of the lens, is a common adverse effect of first-generation antipsychotic medications. Newer generation antipsychotics, also known as atypical antipsychotics, are less commonly associated with cataract. A 19-year-old girl with underlying schizophrenia on olanzapine for the past two years complained of gradual blurring of vision in both eyes for four months prior to presentation. On examination, the best corrected visual acuity was counting finger in both eyes. The anterior segment examination showed bilateral diffuse cortical cataract precluding fundus examination. Systemic examination was unremarkable. Blood investigations revealed a high random blood sugar, which normalised after she was initiated on oral hypoglycemic medication. After bilateral lens aspiration, her visual acuity was 6/6 bilaterally. Olanzapine may be cataractogenic via its action as a serotonin antagonist, which results in reduced glucose responsiveness of the pancreatic beta-cells. Patients on anti-psychotic medication are at risk of developing diabetes mellitus and cataract compared to the general population. Screening for diabetes mellitus should be part of the follow-up of these patients. Ophthalmological evaluation is warranted in the presence of visual complaints.

Adverse ocular effects of neuroleptic therapy: semiotics, pathogenesis and treatment

“…Атипичные нейролептики редко вызывают развитие помутнений хрусталика: описаны лишь единичные случаи, связанные с использованием клозапина, оланзапина, зипрасидона и рисперидона [25]. Атипичные антипсихотические препараты обладают гипергликемическим эффектом, что потенциально увеличивает риск появления диабетической катаракты [28,29]. Однако крупное ретроспективное исследование, проведенное P. Chou и соавт.…”