Eyelids and anterior segments: Case ten

This 65 year old man was a long-stay patient in a psychiatry hospital. He had been treated for schizophrenia since the age of 30. Recently, he complained of blurred vision in both eyes. Slit-lamp examination showed the above appearance.

a. What is seen in this picture?
 

Anterior subcapsular cataract in a stellate pattern

b. What is the most likely cause in this patient?
 

Chlorpromazine-induced, this antipsychotic drug has been used extensively since 1953 in treating patient with schizophrenia. The cataract is the result of deposition of the yellowish-brown granules under the anterior lens capsule. This usually occurs after the accumulative doses of more than 500g. This type of cataract rarely causes decreased visual acuity. This patient's poor was attributed to age-related macular degeneration.

c. What other ocular signs may occur in this patient?
 

Ocular manifestations of chlorpromazine therapy include:

• photosensitivity of skin such as eyelids in sun-exposed area
• interpalpebral conjunctival pigmentation
• deep corneal stromal and endothelial pigmentation
• pigmentary retinopathy
• accommodative paresis due to anticholinergic effect