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CASE REPORT
Amiodarone Induced Ocular Toxicity
Surbhi Gupta*, Vishal R Tandon,Vijay Khajuria, Vivek Mahajan, Neelam Rani, Roshi
Abstract
Many systemic drugs like bisphosphonates, topiramate, vigabatrin, isotretinoin and other retinoids, ethambutol,
chloroquine and hydroxychloroquine, tamoxifen, quetiapine, cyclo-oxygenase (COX)-2 inhibitors are known
to produce ocular toxicity.We herby report ocular toxicity with amiodarone showing presence of bilateral
arborising horizontal lines in the corneal epithelium in a pattern resembling cat's whiskers in a 36 years old
male patients prescribed for WPW Syndrome.
Key Words
Amiodarone, Ocular Toxicity, Adverse Drug Reaction
Received- 14.12.13
Revised -01.1.14
Accepted-15.1.14
From the *RD Sood Eye Care & Research Centre and Department of Pharmacology, Govt. Medical College Jammu
Correspondence to : Dr. Vishal R Tandon, Incharge ADRM Centre, Deartment of Pharmacology.
E-mail: [email protected]
Introduction
Amiodarone is an iodine-rich benzofuran derivative
with well known ocular, dermatologic, gastrointestinal,
neurologic, cardiovascular, thyroid and pulmonary toxicity.
Therefore reserved for use in patients with refractory
and/or life-threatening supraventricular and ventricular
tachyarrhythmias. [1]
Many systemic drugs beside amiodarone like
bisphosphonates, topiramate, vigabatrin, isotretinoin and
other retinoids, ethambutol, chloroquine and
hydroxychloroquine, tamoxifen, quetiapine, cyclooxygenase (COX)-2 inhibitors are known to produce
ocular toxicity. [2]
Toxic keratopathy and maculopathy, comeal microdeposits,lens opacities, optic neuropathy has been
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described with amiodarone treatment. [3-6] Event
simultaneous multisystem involvement is also reported
with long term use of amiodarone. [7-8]
Although ocular toxicity with amiodarone is well
reported but some of the ocular damages produced by it
are irreversible. This warrants a need to create awareness
for extensive ocular screening and follow up of such
patient on amiodarone. Thus, the case is worth reporting
Case Report
A 36-year-old man presented with symptoms of visual
"shining," glare, color vision anomalies, and gradually
decreased vision soon after initiation of amiodarone HCl
(200 mg/day) prescribed for WPW syndrome by the
cardiologist. Eye examination revealed classical picture
J Rational Pharmacother Res
Vol. 2 No.1,January - March 2014
J Rational Pharmacother Res
An Official Publication of ISRPT
Fig.1 Showing the classical picture of amiodarone toxicity showing presence of bilateral arborising horizontal lines in the
corneal epithelium in a pattern resembling cat's whiskers. This whorl like pattern originates from point below the pupil
and swirls outwards, sparing the limbus.
of amiodarone toxicity showing presence of bilateral
arborising horizontal lines in the corneal epithelium in a
pattern resembling cat's whiskers. This whorl like pattern
originated from point below the pupil and swirls outwards,
sparing the limbus. Amiodarone was discontinued after
discussion with the cardiologist and tablet flecanide 100
mg in morning and 50 mg in night was prescribed as an
alternative treatment. On follow up, the patient reported
disappearance of symptoms with 7 days. Visual acuity
had improved. Ishihara color plates showed normal color
vision with in 15 days.
The patient had no history of smoking, alcohol or drug
abuse. There was no associated pathology or history of
concurrent drug intake. He had no similar family history.
Clinical examination revealed normal pulse rate, blood
pressure was 128/88 mm of Hg, chest examination,
abdomen and CNS examination were also within normal
limits. Laboratory investigations showed, haemoglobin
10.2 gm/dl, total leukocyte count-11000 cu3mm, blood
sugar fasting-90 mg/dl, thyroid profile - normal,
erythrocyte sedimentation rate-12 mm/hr, serum ureaVol. 2 No. 1, January - March 2014
21 mg/dl, serum creatinine-0.7 mg/dl, HIV-I&II - non
reactive, serum bilirubin - 0.4 mg/dl, aspirate transferase32 mg/dl, alanine transferase 42 mg/dl, electrolytes were
within normal limits, X-ray, ultrasonography abdomen &
CT Scan head were normal.
Discussion
The temporal relationship, brief de-challenge improved
the condition and re-challenge was not done in this case
due to ethical and clinical constrain. Furthermore, the
appearance of ocular changes could not be explained by
any concurrent disease, drug or chemical. ADR was
probable as assessed by WHO Uppasla Monitoring
Centre causality scale and Naranjo's score came out to
be six. [9, 10]
The ADR was not studied for dose dependent
response and in view of its uncertain mechanism it is
difficult to comment on type of ADR.
Amiodarone is a benzofuran derivative that has been
effective for the treatment of both supraventricular and
ventricular tachyarrhythmias. Due to ocular, dermatologic,
gastrointestinal, neurologic, cardiovascular, thyroid and
J Rational Pharmacother Res
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J Rational Pharmacother Res
An Official Publication of ISRPT
pulmonary toxicity, amiodarone should be reserved for
use in patients with refractory and/or life-threatening
arrhythmias.
Furthermore current case report highlights and
recommends the ocular screening to avoid major loss of
visual function in patient taking amiodarone.
5.
Castells DD1, Teitelbaum BA, Tresley DJ. Visual changes
secondary to initiation of amiodarone: a case report and
review involving ocular management in cardiac
polypharmacy. Optometry 2002 ; 73(2):113-21.
6.
Chassang B1, Bonnin N2, Moisset X3, Citron B4, Clavelou
P3, Chiambaretta F5.Two cases of bilateral amiodaroneassociated optic neuropathy. J Fr Ophtalmol 2014
;37(3):231-6.
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Multisystem Side Effects of Amiodarone. Am J Med Sci.
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Santaella RM1, Fraunfelder FW. Ocular adverse effects
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Bratulescu M, Zemba M, Gheorghieva V, Andrei S, Cucu
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Source of Support
Nil
Conflict of Interest
Not Declared
Ul Rehman S, Siddiqui N, Khan NS, Sobia R, Assaly R.
Chuang CL1, Chern MS, Chang SC. Amiodarone toxicity
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Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts
EA, et al. A method for estimating the probability of adverse
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How to Cite This Article : Gupta S, Tandon VR, Khajuria V, Mahajan V, Rani N, Roshi. Amiodarone Induced Ocular
Toxicity. J Rational Pharmacother Res 2014; 2(1): 28-30
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J Rational Pharmacother Res
Vol. 2 No.1,January - March 2014