Digoxin toxicity. Recognizing the varied visual presentations

Area of Science:

• Ophthalmology
• Toxicology
• Neuroscience

Background:

• Digoxin is a cardiac glycoside used to treat heart failure and arrhythmias.
• Classic visual symptoms of digoxin toxicity include xanthopsia (yellow vision).
• Retinal dysfunction is increasingly implicated in the pathogenesis of digoxin toxicity.

Observation:

• Three patients presented with decreased visual acuity due to digoxin toxicity.
• Xanthopsia was notably absent in these cases.
• One patient experienced visual symptoms exclusively, while another had complicated presentation due to retinitis pigmentosa.

Findings:

• Visual function improved significantly after reducing blood digoxin levels.
• Electroretinography (ERG) suggested cone dysfunction in one patient.
• These findings support retinal dysfunction as a mechanism in digoxin toxicity.

Implications:

• Digoxin toxicity should be considered in patients with unexplained visual loss.
• Ophthalmologists and neurologists may be the first to diagnose this condition.
• Early recognition and management are crucial for potentially life-threatening digoxin toxicity.