Drugs Affecting CorneaVortex keratopathy/ cornea verticillata: characterized by whorl-like corneal epithelial deposits.

1. Signs:• Bilateral, fine greyish or golden-brown opacities

in the inferior corneal epithelium.• Arborizing horizontal lines

Drugs Affecting Cornea

Causes: a. Antimalarial

Chloroquine (Nivaquine, Avlocor)Hydroxychloroquine (Plaquenil)

• INDICATIONS: malaria; certain rheumatological disorders• Unlike retinopathy, keratopathy bears no relationship to dosage or duration

of treatment. • reversible on cessation of therapy.

Drugs Affecting Cornea

b. Amiodarone • INDICATIONS: atrial fibrillation; ventricular

tachycardia• keratopathy - slowly reversible on

discontinuation of medication.• Higher dose/ longer duration of

administration more advanced the corneal deposits.

• keratopathy does not affect vision- discontinuation not indicated.

• Other toxic effects- anterior subcapsular lens deposits optic neuropathy

Drugs Affecting CorneaCHLORPROMAZINE:INDICATIONS- sedative; psychotic illnessesSIGNS- innocuous, subtle, diffuse yellowish-brown

granular deposits in the endothelium, Descemet membrane and deep stroma occurring only in exposed cornea of the interpalpebral fissure

anterior lens capsule deposits retinopathy

Doses greater than 500 mg/day given for prolonged periods have a higher incidence of irreversible corneal and lenticular deposits.

Drugs Affecting CorneaARGYROSIS:

discoloration of ocular tissues secondary to silver deposits, and may be iatrogenic or from occupational exposure.

Keratopathy is characterized by greyishbrown granular deposits in Descemet

membrane.

The conjunctiva may also be affected.

Drugs Affecting CorneaCHRYSIASIS:• Deposition of gold in living tissue, occurring after prolonged administration.• treatment of rheumatoid arthritis. SIGNS:• Corneal chrysiasis :

– characterized by dust-like or glittering purple granules scattered throughout the epithelium and stroma, more concentrated in the deep layers and the periphery.

– total dose of gold compound >1500 mg develop corneal deposits. – not an indication for cessation of therapy.

• innocuous lens deposits• marginal keratitis.

Drugs Affecting CorneaAMANTADINE: INDICATIONS: Parkinson disease.

SIGNS:• Diffuse white punctate opacities that may be associated with epithelial

edema, 1–2 weeks after commencement of therapy (dose 200-400 mg/d).• Resolve with discontinuation of treatment.