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Blue Sclera and Retinal Hyperpigmentation in a Patient With Long-term Minocycline Use

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A woman in her 80s complained of mildly distorted vision in both eyes for several months. Best-corrected visual acuity was 20/25 OD and 20/40 OS. Intraocular pressure was 16 mm Hg OD and 17 mm Hg OS. Her medical history included rheumatoid arthritis treated with minocycline, 100 mg twice daily, for more than 10 years. External examination revealed blue-gray discoloration of the nail beds and bilateral sclera (Figure, A). Ophthalmoscopic and optical coherence tomography findings demonstrated a bluish appearance to the macula with associated pigmented retinal pigment epithelium deposits (Figure, B) consistent with minocycline-induced retinal hyperpigmentation.1 The lack of choroidal hyperreflectivity suggested no associated pigmented choroidal nevus. Given the unknown, long-term visual relevance of minocycline-induced retinal hyperpigmentation, the patient was switched from minocycline to methotrexate, 10 mg weekly, with supplementation of folic acid to manage her rheumatoid arthritis.24

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Article Information

Corresponding Author: Jayanth Sridhar, MD, Bascom Palmer Eye Institute, 900 NW 17th St, Miami, FL 33136 (jsridhar1@med.miami.edu).

Conflict of Interest Disclosures: Dr Sridhar reported receiving consultant fees from Alcon, Allergan, Dorc, Genentech, and Regeneron. Grant funding from the National Institutes of Health, the Department of Defense, and an unrestricted grant from Research to Prevent Blindness were provided to the Bascom Palmer Eye Institute. No other disclosures were reported.

Additional Contributions: We thank the patient for granting permission to publish this information and John Kitchens, MD, Retina Associates Kentucky, for his help in preparing this case report. No financial compensation was received for contributions.

References
1.
Wilson  ME , Sridhar  J , Garg  SJ , Forman  AR .  Spectral-domain optical coherence tomographic imaging of pigmented retinal pigment epithelial deposits in a patient with prolonged minocycline use.   JAMA Ophthalmol. 2015;133(11):1360-1362. doi:10.1001/jamaophthalmol.2015.2819PubMedGoogle ScholarCrossref
2.
Ozog  DM , Gogstetter  DS , Scott  G , Gaspari  AA .  Minocycline-induced hyperpigmentation in patients with pemphigus and pemphigoid.   Arch Dermatol. 2000;136(9):1133-1138. doi:10.1001/archderm.136.9.1133PubMedGoogle ScholarCrossref
3.
Bradfield  YS , Robertson  DM , Salomao  DR , Link  TP , Rostvold  JA .  Minocycline-induced ocular pigmentation.   Arch Ophthalmol. 2003;121(1):144-145. doi:10.1001/archopht.121.1.144PubMedGoogle ScholarCrossref
4.
Jung  JJ , Chen  MH , Sorenson  AL , Rofagha  S .  Swept-source optical coherence tomography and OCT angiography of minocycline-induced retinal and systemic hyperpigmentation.   Ophthalmic Surg Lasers Imaging Retina. 2016;47(4):356-361. doi:10.3928/23258160-20160324-09PubMedGoogle ScholarCrossref
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