Fluphenazine and its toxic maculopathy

Ten years ago a 45-year-old female presented with bilateral maculopathy with visual acuity of 6/18 on the right and 6/24 on the left. She had been on fluphenazine for the past 10 years for schizophrenia. Investigation including fluorescein angiogram, colour vision assessment and electrophysiological testing confirmed the nature of the retinal damages. Her maculopathy deteriorated further despite discontinuation of the medication. A previous publication has reported maculopathy with fluphenazine in association with the welding arc injury, but that particular patient had not been exposed to welding flash or other extreme photochemical sources. We believe this is the first reported incidence that fluphenazine has directly caused a maculopathy secondary to its accumulation at the retinal pigment epithelium and its toxic effect.