Which NSAID has unique ocular side effects including whorl keratopathy and retinal pigmentary changes?

• A. Indomethacin
• B. Ibuprofen
• C. Naproxen
• D. Celecoxib

Answer: (A)

This question tests recognizing drug-induced ocular toxicity patterns and which NSAID carries a distinctive eye adverse effect. Whorl keratopathy, or vortex keratopathy, occurs when a drug deposits in the corneal epithelium and creates a spiral pattern seen on exam. Retinal pigmentary changes indicate toxicity affecting the retina. Indomethacin has been reported to cause these unusual ocular effects, including both whorl keratopathy and retinal pigmentary changes, especially with longer use or higher doses. The other NSAIDs listed—ibuprofen, naproxen, and celecoxib—do not typically show this specific combination of corneal vortex changes and retinal pigmentary alterations. If these eye findings occur, discontinuation of the drug can lead to partial or full reversal over time.