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Magnitude of chlorpromazine induced ocular toxicity among psychiatric patients at Melik and Amanuel Hospitals
Abstract
Background: Chlorpromazine (CPZ), a typical anti-psychotic drug, has been associated with irreversible ocular toxicity signs which are dependent on total dosage and duration where exact values varied in different studies. In Ethiopia, there is no data on chlorpromazine induced ocular toxicity.The current study aimed to determine the prevalence of Chlorpromazine induced ocular toxicity.
Method: All consecutive psychiatric patients taking Chlorpromazine at a dose of 100mg/d or more for more than one month were included. Then, socio- demographic data, daily dosage and duration of Chlorpromazine treatment were obtained from self-administered questionnaire as well as patients’ chart review. Visual acuity of each eye was taken using Snellen’s illiterate “E” chart at a distance of 6 meters. Examination was especially directed to the lids and conjunctiva for pigmentation. Complete slit lamp examination was done to look for anterior segment toxicity signs and direct ophthalmoscope for posterior segment findings.
Result: Out of the total 92 patients examined, 30 (32.6%) (95% CI: 22-41.8) had signs of ocular toxicity ie 8 with rosette pigments, 11 with anterior stellate cataract alone and 11 with concomitant anterior stellate cataract and corneal changes. The minimum cumulative total dose resulting in ocular toxicity was in the range between 500gm and 750gm taken more than 5 years. ALL patients having anterior stellate cataract with corneal changes had severe visual impairment.
Conclusion: Chlorpromazine is associated with lens and corneal toxicity at a minimum cumulative dose ranging between 500gm and 750gm taken more than 5 years. Patients with concomitant lens and corneal changes had severe visual impairment. Close and combined management of patients on Chlorpromazine between ophthalmologists and psychiatrists is recommended.
