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

Abstract

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.

Impact of Nontreatment Duration and Keratopathy on Major Adverse Cardiovascular Events in Fabry Disease: A Nationwide Cohort Study

“…Amiodarone has been associated with keratopathy [39,40]; therefore, caution is advised when considering the use of amiodarone in patients with FD, although there is insufficient research and evidence to reach a consensus [1,41]. In this study, patients with FD with or without keratopathy exhibited no significant difference in amiodarone use.…”

DICED - anti-depressant drug-induced corneal endothelial deposits

“…[ 1 ] Drug induced corneal endothelial deposition is a rare adverse effect and is reported in patients using antipsychotic drugs like chlorpromazine (typical antipsychotic), clozapine (atypical antipsychotic), and Rifabutin (antibiotic). [ 2 ] Changes in aqueous humor flow caused by these drugs lead to deposition of drug deposists on the anterior lens capsule and corneal endothelium. In addition, photosensitizing drugs like chlorpromazine, denature proteins that form opacities that accumulate over the lens, cornea and skin under exposure to sunlight.…”

“…Vortex keratopathy (epithelial) is commonly caused by drugs such as amiodarone, antimalarials, suramin, tamoxifen, chlorpromazine (CPZ), and non-steroidal anti-inflammatory drugs. [ 2 ] Stromal deposits can be visually significant and are caused by CPZ, gold, rifabutin, indomethacin, and tyrosine kinase inhibitors. Rifabutin and CPZ can result in endothelial deposits that are usually asymptomatic.…”