A 76-year-old man is started on amiodarone for treatment of paroxysmal atrial fibrillation. After several months of therapy, he has a routine eye examination. Corneal deposits are noted by his ophthalmologist. If amiodarone is continued, which of the following is most likely to occur because of the drug?
A) Decreased visual acuity
B) Macular degeneration
C) Cataracts
D) Retinal detachment
E) No visual changes
Answer E (correct answer): Corneal deposits occur in most patients on long term amiodarone therapy. These are caused by amiodarone secretion by the lacrimal glands leading to accumulation in the cornea. These deposits are easily visualized on ophthalmologic examination. In most cases, they lead to no visual changes or eye pathology.
Answer A (incorrect answer): Corneal deposits may occur with long term amiodarone use but they do not usually lead to changes in visual acuity.
Answer B (incorrect answer): Macular degeneration is the accumulation of drusen in the macula. This leads to slowly progressive loss of central vision.
Answer D (incorrect answer): Retinal detachment occurs when the retina loses its attachment to the vascular choroid layer of the eye.
Answer C (incorrect answer): Cataracts are opacifications of the lens. They are common among older patients and those with diabetes. Glucocorticoid therapy is associated with an increased risk of cataracts.