Atypical amiodarone-induced keratopathy in a patient wearing soft contact lenses

Antiarrhythmic therapy with amiodarone hydrochloride may produce a pattern of vortex corneal epitheliopathy or cornea verticillata. The vortex keratopathy typically occupies the lower third of the cornea, extends superiorly, and is graded according to the degree of extension. Grades I through III describe the amount of vortex change, whereas grade IV describes a generalized granular dusting in addition to the vortex pattern. Grade IV amiodarone-induced keratopathy has been reported from Europe, but no North American series have reported this more advanced epithelial change. We describe a patient who developed grade IV amiodarone-induced keratopathy while wearing soft contact lenses. Of 686 patients treated with amiodarone at the Mayo Clinic and undergoing routine follow-up, this is the first case of grade IV keratopathy we have observed. To our knowledge, this is also the first report of a patient who wore contact lenses and developed this uncommon corneal change while taking amiodarone.