Maurice F. Rabb » Progressive Visual Acuity (VA) Loss

This 68 year old white female was evaluated by the Retina Service of Wills Eye Hospital on June 28, 1984. At that time she complained of severe progressive VA loss ou of approximately 12 years duration. Twenty years ago she had been diagnosed as having schizophrenia and had been taking Mellaril 100 mg po daily for the last 18 years. She had no other previous illnesses and her family history was not contributory. She was on no other medications.

Ocular examination revealed V.A. on HM. OD and 20/80 OS. Slit lamp biomicroscopy was normal. Tensions were 18 mm ou by applanation tonometry. Fudus examination demonstrated extensive RPE and choroidal thinning and loss. The accompanying fluorescein angiogram confirms the extensive loss of choroid and RPE with only the retinal vascularature and larger deepr choroidal vessels being evident.

The work oup included a CBC which was normal, FTA-Ab which was negative, Goldmann perimetry which showed moderated generalized construction and paracentral scrotomas ou. Color vision testing using the Farnsworth D-15 which was markedly abnormal O.D. but normal O.S. and an ERG with no recordable activity to either photopic or scotopic stimulation.

This patient's only other previous eye exam was on February 6, 1973. At that time visual acuity was 20/100 OD and 20/40 OS. Fundus examination showed choroidal RPE thinning of moderate severity more pronounced in the macular regions ou. This is also confirmed by the accompanying angiogram. These changes were felt to be due to Mellaril toxicity at this time but despite advice to the contrary she was continued in Mellaril therapy.

We feel the above fundus changes most likely represent those due to Mellaril toxicity. However, this conclusion remains presumptive.