Crystalline deposition in the cornea and conjunctiva secondary to long-term clofazimine therapy in a leprosy patient

Barot, Rakesh K; Viswanath, Vishalakshi; Pattiwar, Madhuri S; Torsekar, R G

doi:10.4103/0301-4738.82012

Cited by 16 publications

(11 citation statements)

References 4 publications

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“… 58 Another study revealed polychromatic crystalline deposits accompanied by red-to-brown staining of the bulbar conjunctiva and peripheral cornea, with no visual impairment. 60 All of these changes were reversible after treatment cessation.…”

Section: Drug Classes Overviewmentioning

confidence: 98%

Drug-induced corneal deposits: an up-to-date review

2022

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This review assesses different clinical aspects of the various known drug-induced corneal deposits, based on the corneal layer involved (epithelium, stroma and/or endothelium), and based on the drug class. The most well-known condition caused by drug deposits is vortex keratopathy, or corneal verticillata, which is a whorl-like opacity in the corneal epithelium. Vortex keratopathy is commonly caused by certain cationic amphiphilic drugs such as amiodarone, antimalarials, suramin, tamoxifen, chlorpromazine and non-steroidal anti-inflammatory drugs. These deposits usually occur once a certain dose of the drug is reached. Most cases present with mild to moderate symptoms with minimal visual impairment. Most of these deposits resolve automatically, after months to years of drug cessation. Notably, other drug classes can cause deposits in all three layers of the cornea. Chlorpromazine, gold, rifabutin, indomethacin and tyrosine kinase inhibitors can cause stromal deposits, with reduced visual acuity when the anterior stroma is involved. Chlorpromazine and rifabutin can also cause deposits in the endothelial layer of the cornea. Regardless of the type of corneal deposit, local therapies such as topical lubricants or corticosteroids may help improve symptoms. Drug cessation or modification can also be helpful but should be weighed against the systemic risks of the underlying disease.

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Section: Drug Classes Overviewmentioning

confidence: 98%

Drug-induced corneal deposits: an up-to-date review

2022

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“…However, it must be noted that human macrophages are the primary host cells for Mtb , and thus, such a property will be of decisive clinical advantage when using clofazimine [ 92 ]. Moreover, accumulation of clofazimine in adipose cells such as in the heart, liver, breasts, adrenal glands, pancreas, spleen, bone marrow and lamina propria of the jejunum, extends the half-life to 65–70 days [ 88 , 89 , 90 , 95 , 107 , 108 , 110 , 111 , 112 , 113 , 114 ]. However, such accumulation leads to adverse reactions including reversible skin, hair and corneal dyschromia to brownish-black, dark red, or even to orange pink.…”

Section: Clofazimine An Orphan Drugmentioning

confidence: 99%

“…However, such accumulation leads to adverse reactions including reversible skin, hair and corneal dyschromia to brownish-black, dark red, or even to orange pink. Approximately 46% of patients receiving clofazimine treatment display conjunctival deposition, whereas nearly 53% experience crystal deposition in the cornea and 32% of patients present with clofazimine crystals in their tears [ 114 , 115 ]. Deposition of a dark-brown pigmentation is furthermore sometimes visible on the fingernails.…”

Section: Clofazimine An Orphan Drugmentioning

confidence: 99%

Adapting Clofazimine for Treatment of Cutaneous Tuberculosis by Using Self-Double-Emulsifying Drug Delivery Systems

2022

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Although chemotherapeutic treatment regimens are currently available, and considerable effort has been lavished on the development of new drugs for the treatment of tuberculosis (TB), the disease remains deeply intractable and widespread. This is due not only to the nature of the life cycle and extraordinarily disseminated habitat of the causative pathogen, principally Mycobacterium tuberculosis (Mtb), in humans and the multi-drug resistance of Mtb to current drugs, but especially also to the difficulty of enabling universal treatment of individuals, immunocompromised or otherwise, in widely differing socio-economic environments. For the purpose of globally eliminating TB by 2035, the World Health Organization (WHO) introduced the “End-TB” initiative by employing interventions focusing on high impact, integrated and patient-centered approaches, such as individualized therapy. However, the extraordinary shortfall in stipulated aims, for example in actual treatment and in TB preventative treatments during the period 2018–2022, latterly and greatly exacerbated by the COVID-19 pandemic, means that even greater pressure is now placed on enhancing our scientific understanding of the disease, repurposing or repositioning old drugs and developing new drugs as well as evolving innovative treatment methods. In the specific context of multidrug resistant Mtb, it is furthermore noted that the incidence of extra-pulmonary TB (EPTB) has significantly increased. This review focusses on the potential of utilizing self-double-emulsifying drug delivery systems (SDEDDSs) as topical drug delivery systems for the dermal route of administration to aid in treatment of cutaneous TB (CTB) and other mycobacterial infections as a prelude to evaluating related systems for more effective treatment of CTB and other mycobacterial infections at large. As a starting point, we consider here the possibility of adapting the highly lipophilic riminophenazine clofazimine, with its potential for treatment of multi-drug resistant TB, for this purpose. Additionally, recently reported synergism achieved by adding clofazimine to first-line TB regimens signifies the need to consider clofazimine. Thus, the biological effects and pharmacology of clofazimine are reviewed. The potential of plant-based oils acting as emulsifiers, skin penetration enhancers as well as these materials behaving as anti-microbial components for transporting the incorporated drug are also discussed.

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“…Crystalline deposits in the anterior stroma of cornea and conjunctiva were noted, which disappeared with discontinuation but reappeared upon reinitiation of clofazimine [47]. Similarly, long-term therapy with clofazimine resulted in numerous polychromatic crystalline deposits within the cornea and conjunctiva in a leprosy patient [48]. A severe case associated with clofazimine therapy has been reported to induce bull’s eye retinopathy.…”

Section: Corneal Manifestationsmentioning

confidence: 99%

Ocular toxicity from systemically administered xenobiotics

Gokulgandhi

Vadlapudi

Mitra

2012

Expert Opinion on Drug Metabolism & Toxicology

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Introduction The eye is considered as the most privileged organ because of the blood–ocular barrier that acts as a barrier to systemically administered xenobiotics. However, there has been a significant increase in the number of reports on systemic drug-induced ocular complications. If such complications are left untreated, then it may cause permanent damage to vision. Hence, knowledge of most recent updates on ever-increasing reports of such toxicities has become imperative to develop better therapy while minimizing toxicities. Areas covered The article is mainly divided into anterior and posterior segment manifestations caused by systemically administered drugs. The anterior segment is further elaborated on corneal complications where as the posterior segment is focused on optic nerve, retinal and vitreous complications. Furthermore, this article includes recent updates on acute and chronic ocular predicaments, in addition to discussing various associated symptoms caused by drugs. Expert opinion Direct correlation of ocular toxicities due to systemic drug therapy is evident from current literature. Therefore, it is necessary to have detailed documentation of these complications to improve understanding and predict toxicities. We made an attempt to ensure that the reader is aware of the characteristic ocular complications, the potential for irreversible drug toxicity and indications for cessation.

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Crystalline deposition in the cornea and conjunctiva secondary to long-term clofazimine therapy in a leprosy patient

Cited by 16 publications

References 4 publications

Drug-induced corneal deposits: an up-to-date review

Drug-induced corneal deposits: an up-to-date review

Adapting Clofazimine for Treatment of Cutaneous Tuberculosis by Using Self-Double-Emulsifying Drug Delivery Systems

Ocular toxicity from systemically administered xenobiotics

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