Transient Cornea Verticillata Associated With Oral Gym Supplements Intake In An Otherwise Healthy Patient: Case Report

To report an unusual case of transient cornea verticillata associated with oral gym supplements intake in an otherwise healthy patient. To highlight the potential role of gym supplements in corneal epithelial deposits

National Ophthalmology Unit, Guatemala City, Central America

A 42-year-old male patient was referred by his gym nutritionist after complain of 2 weeks of photophobia and blurry vision. Ocular history was negative for allergy, trauma and surgery. He denied any oral or topical medications use. He reported uneventful soft contact lens wear. There was no family history of ocular disease. His best corrected visual acuity (BCDVA) at distance was 20/200 (Snellen). Slit lamp examination showed bilateral cornea verticillata, intraocular pressure and fundoscopy were normal. No abnormalities observed in corneal topography and specular microscopy. The anterior segment OCT showed epithelial hyperreflective deposits. Patient reported none of his family members had been suspected of or diagnosed with Fabry disease. He underwent a systemic investigation, including α-galactosidase A levels and genetic testing and all test results were normal. Patient reported heavily oral intake of gym supplements a month before symptoms initiation, that include creatine and mixed amino acids. After one month and discontinuation of the supplements, BCDVA was 20/20 and cornea verticillata was absent, no deposits seen on corneal OCT, also photophobia disappeared. Despite medical and nutritional recommendation for cessation, patient restarted his gym supplements and a month later, photophobia and cornea verticillata reappeared, with BCDVA 20/400. After total discontinuation of the supplements BCDVA returned to 20/20 and corneal epithelial deposits were absent

Cornea verticillata may develop as a manifestation of Fabry disease or multiple myeloma or after medication intake of amiodarone, aminoquinolines, antineoplastic agents and non-steroidal anti-inflammatories. There have been no previous reports of cornea verticillata associated with over-the-counter gym supplements intake. An interesting point in this case is that the cornea verticillata disappeared after discontinuation of the supplements and reappeared within re use, clearly suggesting it’s causal relationship. This case highlights the potential, and yet unknown, role of gym supplements in corneal epithelial deposits. Further long-term observation is required to elucidate the mechanism