Drug-induced Cornea Verticillata: A Report of 2 Cases

Abstract

Cornea verticillata is caused by the deposition of drugs, metabolic substrates, or disease byproducts in the basal epithelial layer of the cornea, it is most associated with amiodarone and Fabry disease. It can also be caused by a variety of other drugs, the most common of which are: Chloroquine and Hydroxychloroquine, Indomethacin, Phenothiazines. We report two cases of drugs induced cornea verticillata, one secondary to prolonged intake of amiodarone and the other to amiodarone and hydroxychloroquine, to understand its pathophysiology, describe its clinical classification and discuss its treatment. The medications that cause this pathology have similar cationic and amphiphilic characteristics that enable them to penetrate the cornea's basal epithelial layer lysosomes and attach to cellular lipids there. These drug-lipid complexes build up as deposits in the cornea and are resistant to enzymatic breakdown. The deposits are generally not visually significant and generally disappear with the cessation of the causative agent. Several case reports have described resolution of whorled cornea with the use of topical heparin.