THE EYE’S ORDEAL WITH MEDICATION: TOXIC OCULAR FINDINGS

This study aims to describe the clinical presentation, management, and outcomes of a patient who developed corneal damage following long-term hydroxychloroquine (Plaquenil) therapy.

A 30-year-old female patient with a history of interstitial lung disease had been using hydroxychloroquine and corticosteroids for more than 10 years. She was referred to the ophthalmology clinic with a preliminary diagnosis of cataract.

On initial ophthalmic examination, the patient’s best-corrected visual acuity (BCVA) was 0.4/0.3 (snellen chart), and intraocular pressure was 10/11 mmHg. The anterior segment examination revealed right corneal stromal opacities and bilateral posterior subcapsular cataracts, while fundus findings were normal.
Cataract surgery was performed on the left eye, leading to postoperative visual improvement. One year later, new stromal opacities developed at the corneal side incisions of the left eye, and the right eye showed progression of stromal opacities.
A detailed medication review confirmed that hydroxychloroquine was the only drug known to cause corneal deposits. The patient was referred to the pulmonology department, and hydroxychloroquine was replaced with nintedanib.

Following discontinuation of hydroxychloroquine, no further progression of corneal opacities was observed at the 3-month follow-up, and partial regression was seen at 5 months. The patient reported subjective visual improvement, and BCVA increased to 0.7.

Corneal toxicity due to hydroxychloroquine is a rare but important adverse effect that may impair vision. While the most common presentation is cornea verticillata, stromal involvement can occur, particularly after long-term or high-dose therapy. Recognition of this complication and discontinuation of the causative medication can lead to partial visual recovery and stabilization of corneal findings.