Vortex keratopathy, characterized by whorl-like corneal epithelial deposits, can be caused by long-term use of antimalarial drugs like chloroquine and hydroxychloroquine. Amiodarone, used to treat arrhythmias, can also cause slowly reversible corneal deposits. Prolonged use of chlorpromazine above 500 mg daily is linked to irreversible corneal and lens deposits. Prolonged administration of medications containing silver or gold can lead to gray-brown or purple corneal deposits respectively, through argyrosis or chrysiasis.

2. Drugs Affecting Cornea
Vortex 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

3. 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.

4. 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

5. Drugs Affecting Cornea
CHLORPROMAZINE:
INDICATIONS- sedative; psychotic illnesses
SIGNS-
 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.

6. Drugs Affecting Cornea
ARGYROSIS:
discoloration of ocular tissues secondary
to silver deposits, and may be iatrogenic
or from occupational exposure.
Keratopathy is characterized by greyish
brown granular deposits in Descemet
membrane.
The conjunctiva may also be affected.

7. Drugs Affecting Cornea
CHRYSIASIS:
• 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.

8. Drugs Affecting Cornea
AMANTADINE:
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.