Corneal changes in long-term chlorpromazine therapy

Objective: To study ocular manifestations in patients who were on long-term use of chlorpromazine. Methods: A retrospective observational case study was made. Three patients, who were diagnosed as Schizophrenia and on long-term use of chlorpromazine for more than 20 years, were examined retrospectively. The examinations included clinical history, physical examination, slit-lamp biomicroscopy, and fundus examination. Confocal microstructure analyses of corneal changes were also performed on two cases. Results: A series of three cases, a 52-year-old woman, and two men of 45-year-old and 56-year-old, had a history of prolonged chlorpromazine use and presented with gradual onset of blurred vision in their both eyes for years. Slit-lamp biomicroscopy revealed multiple yellowish-white granular deposits on posterior stroma and corneal endothelium. Stellate yellowish-brown pigments deposited in the anterior subcapsular areas were also found. Fundus examination showed neither pigment epithelial mottling nor maculopathy. Confocal microscopic examination of two patients revealed numerous hyper-reflective deposits on the posterior stroma and corneal endothelium. There were no abnormalities in both endothelial cellular morphology and density. Conclusion: We reported ocular manifestations of three patients who were on long-term chlorpromazine therapy. Confocal imaging is useful for detection of abnormality in the corneal structure. Microstructure changes revealed numerous hyper-reflective deposits on the posterior stroma and endothelium without any changes in cellular morphology and density.