Eye and skin changes in psychiatric patients treated with chlorpromazine.

OCULAR effects in patients treated with a phenothiazine derivative were first described by Verrey (1956) and also by Kinross-Wright (1956); these authors found pigmentary retinal changes, and the compound in question (NP.207) was never marketed.The formula of this and related compounds is shown in Fig. 1.May, Selymes, Weekley, and Potts (1960) described pigmentary retinal changes in patients receiving large doses ofthioridazine (Melleril), which differs only from NP.207 in having a methylthio group instead of a chlorine atom.Chlorpromazine (Largactil) (Fig. 1), intro-Methoxalan duced in 1953, has been widely used in general ° ° medicine and in psychiatry, especia.lly in the long- OCH3 term intensive treatment of chronic schizophrenic Phenothiazine patients, and several ocular effects caused by its N use have been reported.Oculogyric crises have H occasionally been observed as a part of the Chlorpromazine [ 11 Parkinsonian syndrome which is sometimes pro- N C4 duced (Ayd, 1961).Blurred vision, due to an CH2-CH2-CH2-l atropine-like action causing a temporary para- s lysis of accommodation, has been reported Thioridazine (Sinha and Mitra, 1955; Giacobini and Lassenius, (Melleril) N SCH3 1954).Jonas (1959) reported a chlorpromazine-CH2 induced miosis.CH2 N Cloud, Hakim, and Griffin (1961), reporting CH3 intra-ocular damage in animals caused by meth-N P 207 rj( 3j oxalan, a photosensitizing agent which is a N C1 phenothiazine derivative, suggested that chlor- CH2 promazine was potentially capable of causing cH2 similar damage.This led Bock and Swain (1963) CH3 to investigate nineteen patients under 55 years of FIG.1.-Chemical structure of substances age who had received at least 200 mg.chlorpro-mentioned.mazine daily.They observed two cases of raised intra-ocular pressure and queried its significance.They reported no corneal or lens changes attributable to the drug, although they did mention that one 50-year-old patient had "powdery white spots" on the anterior capsule in the central pupillary area.