Amiodarone induced optic neuropathy

Abstract

Aim: To determine the clinical features of amiodarone induced optic neuropathy, which may help distinguish it from non-arteritic anterior ischaemic optic neuropathy.

Methods: Retrospective observational case series of patients diagnosed with amiodarone induced optic neuropathy at the neuro-ophthalmology service from March 1998 to February 2001. Amiodarone was discontinued after discussion with the patient's cardiologist. Visual acuity, colour vision, automated perimetry, and funduscopy were performed on initial and follow up examinations.

Results: Three patients with amiodarone induced optic neuropathy presented with mildly decreased vision, visual field defects, and bilateral optic disc swelling. Upon discontinuing the medication, visual function and optic disc swelling slowly improved in all three patients.

Conclusion: Amiodarone induced optic neuropathy can present with visual dysfunction, and is typically a bilateral process. Upon discontinuation of amiodarone, slow resolution of optic disc swelling occurs and visual function improves in some patients.

Figure 1

Case 1. (A) left eye, superior and inferior nasal step; right eye, inferior nasal step, (B) improved bilaterally. Case 2. (C) left eye, superior arcuate defect; right eye, superior and inferior arcuate defects, (D) improved bilaterally. Case 3. (E) bilateral inferior altitudinal defects, (F) left eye, stable; right eye, improved. Right eyes on right side of figure, left eyes on left side of figure.

Figure 2

Fundus photographs on initial presentation in case 2 showing superior sectoral optic disc swelling in the right (A) and left eye (B). Four months later, minimal disc swelling persists in the right eye (C), with resolution in the left (D).