Cornea Verticillata – a Rare Complication of Chloroquine Toxicity. Case Report

Abstract

IntroductionCornea verticillata is characterized by bilateral grayish or golden-brown linear opacities in a typical vortex shape, mainly in the lower segments of the corneal epithelium, without covering the corneal stroma. It is most often associated with taking amiodarone but can be induced by other medications. Chloroquine is commonly used in treatment and prevention of protozoal diseases. Additionally, it has applications in dermatology and rheumatology as an anti-inflammatory agent in collagenosis, rheumatoid arthritis or lupus erythematosus. Its ophthalmic side effects and their management are noteworthy and are briefly summarized in this paper.Material and MethodsWe present a case of a 62-year-old female patient who was referred to the clinic for diagnosis of corneal lesions detected incidentally during a follow-up examination 6 months after starting treatment with chloroquine for rheumatoid arthritis.ResultsThe patient was diagnosed with cornea verticillata and informed that it does not affect visual acuity and is not an indication for changes in therapy. Discontinuation of medication results in partial or, in some cases, complete resolution of changes.DiscussionIt is important to closely monitor patients taking drugs that are known to have ophthalmic side effects for the first time in new indications. We should consider eye side effects when treating systemic disease and recommend screening tests.ConclusionsA baseline ophthalmic examination should be performed on all patients before initiating use of chloroquine. Moreover, chloroquine can lead to permanent loss of visual acuity contributing to bull’s eye maculopathy, which is irreversible.