[First unilateral, later bilateral optic neuropathy. Amiodarone as the cause?]

Amiodarone has many severe side-effects and can cause keratopathy and neuropathy. We report the case of a 79-year-old male patient with progressive visual loss and papilloedema of the right eye during therapy with amiodarone. To reduce papilloedema he was treated with corticosteroids. Amiodarone therapy was then discontinued, but there was no considerable improvement and after 6 weeks visual loss occurred in the left eye as well.

With regard to the findings we consider this case to be an amiodarone-induced optic neuropathy. According to our knowledge only 19 cases have been reported in the literature but the results of one study indicate that the incidence of optic neuropathy is as high as 1.79%. The pathophysiology of the optic nerve damage remains unclear and an effective treatment is not available. It might be possible that the accelerated elimination of amiodarone with colestyramine could be suitable to prevent optic neuropathy of the second eye.