Conjunctival and Macular Hyperpigmentation Associated with Tetracyclines: Case Reports and Review of Literature

Introduction Tetracycline and its derivatives are widely known to cause hyperpigmentation in various sites throughout the body; of all tetracyclines, this is most often associated with minocycline and is very seldom associated with doxycycline. The sclera, conjunctiva, and macula are among the sites that may be affected. Here, we present several such cases along with a literature review of the few existing reports of tetracycline-associated conjunctival or macular hyperpigmentation. Case Reports Tetracycline-induced (primarily minocycline) conjunctival pigmentation has been reported in only 15 previous patients. Herein, we present a collection of three additional patients with palpebral conjunctival hyperpigmentation associated with long-term tetracycline derivative use. Among these is a unique case of tetracycline-naive doxycycline-associated conjunctival hyperpigmentation. Another of these is the fourth patient reported to have minocycline-associated macular hyperpigmentation. We also offer a case of scleral and type II cutaneous hyperpigmentation associated with minocycline. Conclusions Scleral, conjunctival, and macular hyperpigmentation are associated with tetracycline use; as these are a commonly prescribed drug class, practitioners must be aware of the potential ocular consequences.