title: A Case Report: Anti-Psychotic Agents Related Ocular Toxicity.
abstract: Chlorpromazine is known to cause ocular pigmentary deposits. However, delayed presentation after cessation of chlorpromazine has not been reported. There are also no reports on whether newer generation of anti-psychotic agents contribute to ocular toxicity. We describe a case of ocular toxicity related to anti-psychotic agents. To the best of our knowledge, this is the first reported case of anterior segment pigmentary deposits associated with olanzapine use, 2 years after the cessation of chlorpromazine. We report a case of ocular toxicity in a patient with history of chlorpromazine usage of 100 mg per day for 13 years and subsequently switched to olanzapine 5 mg for 2 years. There were no signs of ocular toxicity while the patient was on chlorpromazine. However, when the patient switched to olanzapine, she developed the ocular side effect as described for chlorpromazine-induced ocular toxicity, with pigmentary depositions on both corneas and the anterior lens surface and decrease in vision. Olanzapine, a newer anti-psychotic agent, may play a role in the ocular pigmentary deposition, either directly causing pigmentary deposition itself or accentuating the effect of chlorpromazine as the 2 drugs act on the same receptors, although further studies are required to support this hypothesis. As patients with psychiatric conditions may not voluntarily complain of visual symptoms, ocular screening could be considered in these patients receiving chronic anti-psychotic treatment, so that any ocular toxicity could be diagnosed in a timely manner.
authors.affiliation: From the Department of Ophthalmology (BNKC, ALKN, JWHS, JSML), LKS Faculty of Medicine, The University of Hong Kong; and Department of Ophthalmology (MCYF), Queen Mary Hospital, Hong Kong SAR, People's Republic of China.
authors.forename: Bonnie Nga Kwan
authors.initials: BNK
authors.lastname: Choy
authors.forename: Alex Lap Ki
authors.initials: ALK
authors.lastname: Ng
authors.forename: Jennifer Wei Huen
authors.initials: JWH
authors.lastname: Shum
authors.forename: Michelle Ching Yim
authors.initials: MCY
authors.lastname: Fan
authors.forename: Jimmy Shiu Ming
authors.initials: JSM
authors.lastname: Lai
mesh_terms: D000368:Aged; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001569:Benzodiazepines / Q000009:adverse effects* / Q000627:therapeutic use; D002746:Chlorpromazine / Q000009:adverse effects* / Q000627:therapeutic use; D005128:Eye Diseases / Q000139:chemically induced*; D005260:Female; D006801:Humans; D000077152:Olanzapine; D012559:Schizophrenia / Q000188:drug therapy
chemical_list: D014150:Antipsychotic Agents; D001569:Benzodiazepines; D000077152:Olanzapine; D002746:Chlorpromazine