Amiodarone and Eye

Q: If corneal microdeposits are noted in patients on Amiodarone therapy, it should be considered serious, and Amiodarone should be stopped immediately to avoid blindness.

A) True

B) False

Answer: B

Corneal microdeposits and/or lenticular opacities are common in patients on amiodarone therapy. This is due to the secretion of amiodarone by the lacrimal gland, which accumulates on the corneal surface. It is popularly known as cat's whiskers and is visible at the juncture of the lower one-third and upper two-thirds of the cornea. This is a dose-dependent effect and gets resolved a few months after stopping the drug. This more extended resolution is due to the longer half-life of Amiodarone. It does not have profound side effects except that it can be annoying cosmetically. It does not affect visual acuity, though it may cause halo vision with colored rings around lights, especially at night. Some photophobia and blurred vision may occur. These symptoms may get better with lowering the dose. 

Though serious side effects like optic neuropathy or papillopathy may occur but are scarce, other reasons besides Amiodarone toxicity should be ruled out first.

#pharmacology

#toxicity

#cardiology

References:

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

2. Ingram DV. Ocular effects in long-term amiodarone therapy. Am Heart J 1983; 106:902.

3. Passman RS, Bennett CL, Purpura JM, Kapur R, Johnson LN, Raisch DW, West DP, Edwards BJ, Belknap SM, Liebling DB, Fisher MJ, Samaras AT, Jones LG, Tulas KM, McKoy JM. Amiodarone-associated optic neuropathy: a critical review. Am J Med. 2012 May;125(5):447-53. doi: 10.1016/j.amjmed.2011.09.020. Epub 2012 Mar 3. PMID: 22385784; PMCID: PMC3322295.

4. Gittinger JW Jr, Asdourian GK. Papillopathy caused by amiodarone. Arch Ophthalmol. 1987 Mar;105(3):349-51. doi: 10.1001/archopht.1987.01060030069028. PMID: 3827710.