Early Cataract Associated with Psychotropic Drugs: A Series of 12 Cases and Critical Review

Background: Psychotropic medications are widely prescribed for chronic psychiatric disorders and constitute an essential component of modern psychiatric management. Although their systemic adverse effects have been extensively investigated, ocular toxicity remains insufficiently characterized. Phenothiazines have historically been implicated in lens opacities, while the association between newer psychotropic agents and cataract formation remains controversial. Objective: To describe a series of patients presenting with early cataract under chronic psychotropic treatment and to critically review the available literature regarding the potential role of psychotropic medications in cataractogenesis. Methods: A descriptive observational study was conducted involving 12 psychiatric patients receiving long-term psychotropic therapy who presented with progressive visual impairment. Demographic characteristics, psychiatric diagnoses, duration and type of psychotropic exposure, cataract morphology, and associated risk factors were analyzed. Results: The median age was 52 years and the female-to-male ratio was 1.4. The average duration of psychotropic exposure was five years. The most frequently prescribed medications were levomepromazine, olanzapine, and fluoxetine, administered either alone or in combination. Ophthalmological examination revealed posterior subcapsular cataracts, cortico-nuclear cataracts, and total white cataracts. No major conventional cataract risk factors were identified in most patients. Conclusion: Our findings support the hypothesis that chronic exposure to psychotropic medications may contribute to accelerated cataractogenesis. Regular ophthalmological monitoring should be considered in patients receiving long-term psychotropic therapy. Further prospective studies are required to establish causality.