Cornea verticillata

Cornea verticillata, also called vortex keratopathy or whorl keratopathy, is a condition characterised by corneal deposits at the level of the basal epithelium forming a faint golden-brown whorl pattern.[2] It is seen in Fabry disease or in case of prolonged amiodarone intake.[3]

Cornea verticillata
Other namesFleischer vortex[1]
Cornea verticillata: A bilateral, whorl-like corneal pattern of cream colored lines in a patient with Fabry disease.
SpecialtyOphthalmology

Causes

Amiodarone

Fabry’s disease

Chloroquine

Hydroxychloroquine

Indomethacin

Phenothiazines etc.

Presentation

No ocular complaints or visual difficulty is usually present.[3][4]

Pathophysiology

This keratopathy is probably a type of drug-induced lipidosis.[3]

Diagnosis

Slit Lamp Biomicroscopy

With Proper History & Investigation if required

Treatment

There is no recommended treatment for cornea verticillata. The deposits typically resolve with cessation of the responsible agent, and no alteration in medication regimen or further work-up is required.Several case reports have described the resolution of cornea verticillata with the use of topical heparin.

If cornea verticillata is associated with a drug that is known to produce retinal toxicities—most notably hydroxychloroquine, chloroquine, chlorpromazine, and tamoxifen—patients should be routinely monitored with automated visual fields plus spectral-domain optical coherence tomography (SD OCT).The presence of cornea verticillata does not correlate with retinal toxicity.The possibility of optic neuropathy should also be considered if patients taking amiodarone and tamoxifen present with reduced vision. For these patients, a reduction in dose or a switch to a different medication may be necessary.

References
  1. "Definition: 'Cornea Verticillata'". MediLexicon. Retrieved 29 November 2013.
  2. van der Tol, Linda; Sminia, Marije L; Hollak, Carla E M; Biegstraaten, Marieke (2016). "Cornea verticillata supports a diagnosis of Fabry disease in non-classical phenotypes: results from the Dutch cohort and a systematic review". British Journal of Ophthalmology. 100 (1): 3–8. doi:10.1136/bjophthalmol-2014-306433. ISSN 0007-1161.
  3. Chew, E; Ghosh, M; McCulloch, C (June 1982). "Amiodarone-induced cornea verticillata". Canadian Journal of Ophthalmology. 17 (3): 96–9. PMID 7116220.
  4. Graff, Jordan M. (February 21, 2005). "Verticillata". University of Iowa Health Care, Ophthalmology and Visual Sciences. Retrieved 29 November 2013.
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