Corneal Endothelial and Anterior Lenticular Deposits Due to Clozapine

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• Corneal Endothelial and Anterior Lenticular
  Deposits Due to Clozapine
• Nathaniel Nataneli, MD
• Pearl S. Rosenbaum, MD
• Jose Cardona, MS IV
• Martin Mayers, MD

Authors have no financial interest.
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• Purpose To provide the first clinical case
  report in the American literature of ocular
  complications of clozapine therapy.Methods
  Clinical case report of a 56-year-old man with
  schizophrenia treated with clozapine for nine
  years prior to presentation. Complete
  ophthalmologic examination and slit-lamp
  photography was performed.

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Results

• Complete ophthalmologic evaluation revealed best
  corrected distance acuities of OD 20/252 OS
  20/20-1.
• Slit lamp examination was significant for diffuse
  deposition of tan-colored, reticular deposits
  along the corneal endothelium bilaterally.
  Similar deposits were noted along both anterior
  lens capsules, centrally, in a stellate
  configuration.

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Results (cont.)

• The remainder of the ophthalmologic and external
  examinations (including skin) were unremarkable.
• POH The patient was initially examined in 2000
  at which time he was on clozapine there was no
  past history of phenothiazine (thioridazine,
  chlorpromazine) treatment. At that time, only
  lenticular crystalline deposits were noted these
  were attributed to cataractous changes.

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Tan-colored deposits along the corneal
endothelium (OD)
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Deposits along the anterior lens in a stellate
configuration OD
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Pigmentary deposits in a stellate configuration
along the anterior lens capsule, OS
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Results (cont.)

• The pupils were miotic and dilated poorly upon
  instillation of tropicamide 1 and phenylephrine
  2.5.
• The fundus revealed no abnormalities
  specifically, no pigmentary changes were
  observed.

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Conclusion

• This is the first case reported in the American
  literature of clozapine-related corneal and
  lenticular deposits. In the world literature
  (Australia) only one case of clozapine-related
  ocular deposits has previously been reported,
  involving the cornea, lens and retina that
  patient had an associated decrease in visual
  acuity.
• While ocular deposits have been previously
  described with phenothiazine use, this is the
  first case reported in the United States where
  the patient was on clozapine, but had no known
  history of thioridazine use.

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Conclusion (cont.)

• In 2000, deposits were noted on our patients
  lenses and were attributed to cataractous
  changes. In 2007, corneal deposits were noted
  and attributed to guttatta. The progressive
  involvement of the ocular tissues with these
  pigmentary deposits suggests that accumulation of
  pigment in the anterior chamber occurred with
  chronic clozapine use.
• Psychiatrists and ophthalmologists should be
  aware of clozapine-related ocular deposits and to
  include it in the differential diagnosis of
  pigmented, crystalline deposits involving the
  cornea, lens and retina.

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Bibliography

• Borovik AM, Bosch MM, Watson SL. Ocular
  pigmentation associated with clozapine. Medical
  Journal of Australia. 2009 Feb 16190(4)210-1.
• Bock E, Swain J. Ophthalmologic findings in
  patients on long-term chlorpromazine therapy.
  American Journal of Ophthalmology 1963 56
  808-810.