Slit lamp video of a patient with corneal verticillata also know as vortex keratopathy, whorl keratopathy, or Fleischer vortex. Corneal verticillata are these whorl like opacities in the cornea. As shown in the below video, they appear dramatic, but generally cause no decrease in vision or glare to the patient. The etiology can be a systemic disease like Fabry disease and carrier state or even multiple myeloma.
More commonly, we see it from the use of oral medicines including Amiodarone, chloroquine, phenothiazines, and indomethacin. Other medicines include gentamicin, tamoxifen, meperidine, chlorpromazine, atovaquone, suramin, tilorone, perhexiline maleate, and the tyrosine kinase inhibitors vandetanib and osimertinib. Recently, we have seen cornea verticillata with a new glaucoma medicine called Rhopressa (netarsudil ophthalmic solution). These medications have chemical properties that allow them to penetrate a layer in the cornea, where they are resistant degradation. As a result they accumulate as deposits in the cornea and are permanent.