Amiodarone

  • Medication used to control heart rhythm disturbances
  • Ophthalmic side effect: whorl opacities in cornea (cornea verticillata)
  • Usually does not disturb vision
  • Ischemic optic neuropathy linked to amiodarone use, but evidence of causation weak
  • Patients usually have no visual symptoms
  • May rarely report mildly blurred vision or haloes
  • Curved golden brown or gray-white lines originate below center of cornea in both eyes
  • Visible to naked eye but better seen with slit lamp
  • Corneal whorls are subepithelial phospholipid deposits
  • Fabry disease: glycolipidosis caused by deficiency of the alpha-galactosidase A, but...
  • Patients with Fabry disease have characteristic visceral and vascular manifestations
  • Be aware that these deposits are signature of amiodarone use but have no other medical importance
  • Be aware that medical literature links ischemic optic neuropathy to amiodarone use, so if patient has only one sighted eye, consult ophthalmologist about prescribing amiodarone
  • If patient develops sudden vision loss, refer to ophthalmologist to rule out ischemic optic neuropathy
  • Corneal whorls appear within months of starting medication and disappear within months of stopping it
  • Litigation has occurred against physician prescribers of amiodarone, alleging that this medication causes ischemic optic neuropathy, but evidence not convincing