Minocycline-Induced Ocular Ochronosis

Abstract

We report a case of minocycline-induced ocular ochronosis with scleral, retinal, and cutaneous manifestations. A 65-year-old male who had taken minocycline for four years to treat hidradenitis suppurativa, an inflammatory skin condition affecting the apocrine sweat glands and hair follicles, presented for evaluation of discoloration of bilateral sclera, nail beds, and gingiva. Ophthalmic evaluation revealed intact visual acuity, diffuse blue-gray hyperpigmentation of the sclera, more pronounced overlying insertions of the horizontal muscles, without any scleral thinning. Macular optical coherence tomography and fundus exam revealed a blue hue to the underlying choroid with dark deposits in the retinal pigment epithelium. Despite drug discontinuation, after six years the discoloration persisted. Management was directed towards patient tolerability.

Keywords: hyperpigmentation; minocycline; ocular ochronosis; retinal pigment epithelium deposits; scleral hyperpigmentation.

Figure 1. Blue discoloration of sclera with prominence in palpebral aperture. There is an area 5.5 mm posterior to the limbus where the scleral coloration becomes more prominent.

Figure 2. Blue discoloration of oral mucosa (A) and fingernails (B).

Figure 3. A: Anterior segment optical coherent tomography of the temporal left eye showing lack of scleral thinning. B: Anterior segment optical coherent tomography showing lack of scleral thinning nasally.

Figure 4. A: Right eye fundus photography showing bluish appearance to macula. B: Pigmented retinal pigment epithelium deposits seen on optical coherence tomography.