A Rare Case of Fluoxetine-Induced Vortex Keratopathy

TL;DR

A 25-year-old woman developed corneal changes linked to long-term use of the antidepressant fluoxetine, highlighting the rare but reversible side effect of vortex keratopathy.

Contribution

This paper reports a rare case linking fluoxetine, a selective serotonin reuptake inhibitor, to vortex keratopathy, expanding the known drug associations for this condition.

Findings

Bilateral vortex-patterned corneal epithelial deposits were observed in a patient on long-term fluoxetine therapy.

Discontinuation of fluoxetine led to partial regression of corneal deposits and symptomatic improvement.

No systemic disease or other causative medications were identified in the patient.

Abstract

Vortex keratopathy is a distinctive corneal epithelial disorder marked by whorl-shaped deposits, most often linked to prolonged exposure to cationic amphiphilic medications. While classic drug associations are well established, the involvement of selective serotonin reuptake inhibitors remains sparsely documented. This report describes an unusual presentation of vortex keratopathy temporally associated with long-term fluoxetine 40 mg therapy for two years.

A 25-year-old woman receiving treatment for depressive disorder presented with gradually progressive bilateral visual disturbance. Comprehensive ocular examination revealed preserved best-corrected visual acuity but demonstrated bilateral, symmetrical, and vortex-patterned epithelial corneal deposits. Anterior segment optical coherence tomography localized hyperreflective changes to the corneal epithelium, with deeper layers remaining unaffected. No systemic disease, hereditary corneal disorder, or alternative medication known to cause cornea verticillata was identified. The patient had been continuously using oral fluoxetine for two years.

After coordinated discussion with psychiatric services, fluoxetine was withdrawn and replaced with an alternative antidepressant. Conservative ophthalmic management with preservative-free lubricants was initiated, alongside patient counseling regarding prognosis and reversibility. Subsequent follow-up demonstrated progressive symptomatic improvement and partial regression of epithelial deposits on slit-lamp examination, without compromise of visual acuity or emergence of additional ocular pathology.

This case underscores the importance of meticulous drug history assessment in unexplained corneal epithelial disorders. Although rare, fluoxetine-associated vortex keratopathy should be recognized as a reversible adverse effect, enabling timely intervention and coordinated multidisciplinary care.

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