Amiodarone and Eye

Q: 62 years old male with known history of atrial fibrillation and is on chronic amiodarone for many years admitted to ICU with community-acquired pneumonia. A medical student reported finding the corneal ring. Finding of corneal microdeposits is usually a sign of underlying Amiodarone toxicity?

A) True

B) False

Answer: B

Corneal microdeposits are common in long-term amiodarone therapy. Although they are dose-dependent and cause mild symptoms such as colored rings around lights, particularly at night, photophobia, and blurred vision, they are not a warning sign. They rarely affect visual acuity.

In fact, if visual acuity is affected, other causes should be ruled out first, such as change in refractive correction, progression of age-related cataracts, or increased intraocular pressure. Amiodarone can be reduced or discontinued depending on patient's preference and clinical judgment. It should be noted that Amiodarone itself can cause or worsen the cataract (reference #3).

Corneal microdeposits are usually present with lenticular opacities. They are caused by the lacrimal gland secreting amiodarone, which accumulates on corneal surface. The microdeposit appears as a brownish whorl at the juncture of lower one-third and upper two-thirds of the cornea and has been called cat's whiskers.

It gets resolve after few months of drug withdrawal.

#pharmacology

#opthalmology

#cardiology

References:

1. Mäntyjärvi M, Tuppurainen K, Ikäheimo K. Ocular side effects of amiodarone. Surv Ophthalmol 1998; 42:360.

2. Frings A, Schargus M. Recovery From Amiodarone-Induced Cornea Verticillata by Application of Topical Heparin. Cornea. 2017 Nov;36(11):1419-1422. doi: 10.1097/ICO.0000000000001306. PMID: 28834813.

3. Flach AJ, Dolan BJ. Progression of amiodarone induced cataracts. Doc Ophthalmol 1993; 83:323.