Minocycline-induced scleral pigmentation

Minocycline is a commonly used drug in the management of acne and rosacea. Four individual cases of oral minocycline-induced scleral pigmentation are reported in the dermatologic literature. This is the first report in the ophthalmic literature and will add three new cases of probable minocycline-induced scleral pigmentation.

Data on minocycline from the spontaneous reporting systems of the National Registry of Drug-Induced Ocular Side Effects, Food and Drug Administration, World Health Organization, and Lederle Laboratories were reviewed as to minocycline-related scleral pigmentation. Photographs, published cases, discussions with the examining ophthalmologists, and the personal observation of one patient (case 1) are the basis of the authors' conclusions.

Seven cases of probable oral minocycline-induced scleral pigmentation are presented. These changes may or may not be associated with minocycline-induced pigmentary changes in other tissues, such as the skin, teeth, fingernails, bone, thyroid, or mucosa. The characteristic scleral pattern is a blue-gray 3- to 5-mm band starting at the limbus, which usually is enhanced in the palpebral aperture, possible due to the photosensitizing properties of the drug.

Oral minocycline can cause scleral pigmentation. This pigmentation may resolve within years, or it may be permanent.