You are on page 1of 3

PHOTO ESSAY

Regression of Bilateral Optic Disc Edema After Discontinuation of Amiodarone
Roman Shinder, MD, Larry P Frohman, MD, and . Roger E. Turbin, MD, FACS
Abstract: A 54-year-old non-obese woman treated with amiodarone reported blurred vision and had bilateral optic disc edema with relative preservation of visual function. Neurologic examination, brain imaging, and lumbar puncture opening pressures were normal, effectively ruling out increased intracranial pressure. Amiodarone was discontinued and the optic disc edema completely resolved over 15 months. In the absence of alternative explanations for the optic disc findings, amiodarone toxicity is suggested. (J Neuro-Ophthalmol 2006;26:192–194)

A

54-year-old woman with no ocular history reported the recent onset of blurred vision and floaters in the right eye without headaches. She had begun amiodarone 600 mg per day 6 months earlier for atrial fibrillation in the setting of myocardial infarction and had required a pacemaker and placement of a mechanical valve for mitral valve stenosis 8 months earlier. The patient’s other medications included warfarin and zolpidem. Her height was 5 feet 5 inches and she weighed 150 lbs. General physical and neurologic examination was normal without heart failure or cor pulmonale. Visual acuity was 20/15 in both eyes and Ishihara color vision testing was normal. The pupils were equal in size, briskly reactive to light, and without afferent defect. Slit lamp examination were normal with the exception of mild corneal verticillata. Funduscopic examination showed bilateral optic disc edema (Fig. 1) confirmed on optical coherence tomography (OCT) (Fig. 2). Automated static perimetry revealed visual fields with mild blind spot enlargement and minimal peripheral constriction in both eyes (Fig. 3).

FIG. 1. Serial fundus photographs show gradual resolution of bilateral optic disc edema after discontinuation of amiodarone.

Department of Ophthalmology, UMDNJ-NJMS, Newark, New Jersey. Supported by the Research to Prevent Blindness, Inc., New York, NY; Fund for the New Jersey Blind, Newark, NJ; Lions Eye Research Foundation of New Jersey, Newark, NJ; The Eye Institute of New Jersey, Newark, NJ; and the Gene C. Coppa Memorial Fund, Newark, New Jersey. Address correspondence to Roger E. Turbin, MD, FACS, UMDNJNJMS, Department of Ophthalmology, 90 Bergen St., Room 6177, Newark, NJ 07103; E-mail: turbinre@umdnj.edu

192

J Neuro-Ophthalmol, Vol. 26, No. 3, 2006

) 193 . 3. 2.05. Optical coherence tomography (OCT) of the right and left optic nerves at presentation shows optic disc edema with the plane of the image through the horizontal nasotemporal axis. No. 26. OCT scans show gradual resolution of nerve fiber layer thickening over 15 months. Vol. (The black line represents the tomographic plot of the actual nerve fiber layer elevation plotted against age-matched normals [in green] and abnormals [red] at P < 0. The early scans show so much optic disc elevation that the plots are mostly off the upper end of the available scale. 2006 FIG.Optic Disc Edema in a Patient Treated with Amiodarone J Neuro-Ophthalmol.

The clinical severity of this drug-related optic neuropathy has been characterized as milder than that described in anterior ischemic optic neuropathy. 3. Jay WM. Nazarian SM. Chronicity. Over the next 15 months. as occurred in our patient. Ikaheimo K. investigation for increased intracranial pressure was negative. Tuppurainen K. and progression over several months favor drug toxicity.105:349–51. The presence of a pacemaker prevented MR scanning. Automated static perimetry performed 8 months after discontinuation of amiodarone therapy shows regression of blind spot enlargement and constriction. 4. Mantyjarvi M. Ocular side effects of amiodarone. Papillopathy caused by amiodarone. No. A high-resolution CT scan of the head and orbits with contrast was normal. Younge BR. Feiner LA. Furthermore.87:420–2. 3. However. J Clin Neuroophthalmol 1988. 2. including cell count and cytology. Nagra PK. FIG. Visual acuity and color vision testing remained normal throughout the course and visual fields showed continued improvement over the ensuing 7 months (Fig. Kazmier FJ. The optic disc swelling is typically bilateral and symmetric and can be quite marked (4). Mayo Clin Proc 1987.42:360–6.3). 2006 Shinder et al FIG. Asdourian GK. were normal. 4). 3. A lumbar puncture performed at presentation and repeated 2. Automated static perimetry performed at presentation shows mildly enlarged blind spots and mild constriction in both fields. Because we could discover no alternative explanation. Optic neuropathy and amiodarone therapy. 194 q 2006 Lippincott Williams & Wilkins . J Neuroophthalmol 2005. Amiodarone and optic neuropathy: the heart of the matter [Editorial]. Foroozan R.7). 7. 4.J Neuro-Ophthalmol. The optic disc edema was attributed to amiodarone toxicity and this medication was promptly discontinued. Bilateral optic neuropathy associated with amiodarone therapy. we blamed the ophthalmic findings on amiodarone toxicity.62:702–17. Cerebrospinal fluid constituents. the true incidence of amiodarone optic neuropathy and the mechanism by which the drug causes optic neuropathy are incompletely characterized. the visual complaints in patients with amiodarone optic neuropathy may be insidious or difficult to distinguish from other forms of optic neuropathy affecting a similar patient population with cardiovascular risk factors. REFERENCES 1. Arch Ophthalmol 1987. bilateral presentation. Am J Ophthalmol 1999. 1 and 2). Optic disc swelling usually resolves many months after discontinuation of amiodarone (6. Murphy JF. This patient developed bilateral optic disc edema without substantial visual loss mimicking papilledema.127:610–2. Gittinger JW Jr. and patients may have preserved visual function (2. the optic disc edema gradually resolved as shown by serial optic disc photographs and OCT (Figs.8:25–8. 5. Although cited as occurring in up to 1% to 2% of patients taking the medication (1). Savino PJ. 26. Shults WT. Macaluso DC. Visual field defects may be mild and reversible or severe and permanent (5). Murphy MA. et al.25:232–6. Fraunfelder FT. Br J Ophthalmol 2003. et al.5 months into her course revealed normal opening pressures of 160 mm and 150 mm of water. Surv Ophthalmol 1998. Features of amiodaroneinduced optic neuropathy. Vol. Amiodarone induced optic neuropathy. 6.