Amiodarone-related keratopathy and optic neuropathy: case report and literature review

Abstract

Amiodarone, a highly effective yet lipophilic antiarrhythmic drug with prolonged half-life, is associated with systemic and ocular complications. While keratopathy being the most prevalent, affecting 70-100% of long-term users, amiodarone-associated optic neuropathy (AAON), though rare (incidence: 0.36-2%), can induce diverse visual impairments, ranging from mild deficits to profound vision loss. Given that patients on amiodarone frequently possess the risk factors of vascular diseases, it is essential to differentiate the diagnosis of AAON from non-arteritic anterior ischemic optic neuropathy (AION). This study reports a 61-year-old man who developed both corneal deposition and optic neuropathy during systemic amiodarone therapy. We further analyze the clinical features of keratopathy and optic neuropathy caused by amiodarone through a comprehensive literature review, aiming to enhance diagnostic recognition and management strategies.

Keywords: amiodarone; amiodarone-associated optic neuropathy; anterior ischemic optic neuropathy; keratopathy; optic neuropathy.

Figure 1

Binocular images on initial presentation. (A,B) were slit-lamp images of the right and left eyes respectively, showing greyish brown corneal epithelial opacities. (C,D) were fundus images of the right and left eyes respectively, showing disc edema and peridisk bleeding. (E,F) showed binocular perimetry indicating diffuse total defect in the right eye, inferior altitudinal defect and upper arcuate blind spots in the left eye.

Figure 2

Binocular images during follow-up. Two months later after discontinuing of amiodarone, vortex keratopathy of right (A) and left (B) eye regressed absolutely. Five months after discontinuing of amiodarone, complete resolution of papilledema and hemorrhages were observed in right (C) and left eye (D). Slight progression of visual field defect was observed in right (E) and left (F) eye.