Whorl keratopathy (CHAI T) is associated with which drug among the following?

• A. Chloroquine
• B. Hydroxychloroquine
• C. Amiodarone
• D. Tamoxifen

Answer: (C)

Whorl keratopathy is a vortex pattern of deposition in the corneal epithelium caused by certain systemic medications. The drug most classically linked to this pattern is amiodarone. Its highly lipophilic nature and long half-life allow it and its metabolites to accumulate in corneal epithelial cells, forming lamellar inclusions that create the distinctive whorl-like (vortex) appearance on slit-lamp exam. This corneal change is dose-related, often appears after some time on therapy, and can persist after stopping the drug, though vision is usually not significantly affected.

Chloroquine and hydroxychloroquine can also cause corneal verticillata, but they are more famously associated with retinal toxicity (maculopathy) rather than this corneal vortex pattern. Tamoxifen can cause corneal deposits as well, but amiodarone remains the most characteristic association tested.