Font RL, Sobol W, Matoba A. Polychromatic corneal and conjunctival ­crystals secondary to clofazimine therapy in a leper. Ophthalmology 96(3): 311–315, 1989.

Forester DJ, Causey DM, Rao NA. Bull’s eye retinopathy and clofazamine (letter). Ann Int Med 116(10): 876–877, 1992.

Granstein RD, Sober AJ. Drug and heavy metal-induced hyperpigmentation. J Am Acad Dermatol 5: 1, 1981.

Kaur I, Ram J, Kumar B, Sharma VK. Effect of clofazimine on eye in multibacillary leprosy. Indian J Lepr 62(1): 87–90, 1990.

Mieler WF, Williams GA, Williams DF, Sneed SR. Systemic therapeutic agents retinal toxicity. American Academy of Ophthalmology Instruction Course, New Orleans, LA, 26 October 2004.

Moore VJ. A review of side effects experienced by patients taking clofazimine. Lepr Rev 54: 327–335, 1983.

Ohman L, Wahlberg I. Ocular side effects of clofazimine. Lancet 2: 933, 1975.

Walinder PE, Gip L, Stempa M. Corneal changes in patients treated with clofazimine. Br J Ophthalmol 60: 526, 1976.

d.Purpura

e.Hypersensitivity reaction 3. Retina

a.Necrosis

b.Macular exudates

c.Intra-retinal hemorrhages

d.Peripheral powdery deposits 4. Optic nerve

a.Optic neuritis

b.Optic atrophy – toxic states 5. Photosensitivity

6. Visual hallucinations

Possible

1. Subconjunctival or retinal hemorrhages secondary to drug-induced anemia

2. Eyelids or conjunctiva

a.Erythema multiforme

b.Exfoliative dermatitis

c.Lyell’s syndrome

Generic name: Dapsone.

Proprietary names: Generic only.

Primary use

This sulfone is used in the treatment of leprosy and ocular phemigoid.

Ocular side effects

Systemic administration

Certain

1. Decreased vision

2. Eyelids or conjunctiva

a.Edema

b.Hyperpigmentation

c.Urticaria

Clinical significance

Dapsone has few ocular side effects except in massive doses or in the presence of a glucose-6-phosphate dehydrogenase deficiency. Daneshmend and Homeida (1981), Kenner et al (1980) and Alexander et al (1989) described retinal and optic nerve findings in overdosed patients. These include massive retinal necrosis, yellow-white lesions in the macula, ­intra-retinal hemorrhages and varying degrees of optic nerve damage. Alexander et al (1989) described two cases, one with long-term therapy of dapsone and another case of overdose in an attempted suicide. There was massive deposition of grayish-white material in the macula with a relatively clear fovea. Scattered powdery deposits were seen in the peripheral retina. They felt that the drug or its metabolites were in the inner layers of the retina. This cleared over time. Permanent blindness has occurred in some cases. These findings, at lower doses, may be seen in patients with glucose 6-phosphate