NON-ARTERITIC AION IN PATIENTS ON AMIODARONE THERAPY

My experience has shown that development of non-arteritic AION in patients who happen to be on Amiodarone therapy has erroneously been described as “Amiodarone Optic Neuropathy” and attributed to toxic effects of Amiodarone. But this is a mistake. I have found that in these eyes the clinical symptoms and signs are almost always typically those of non-arteritic AION and are not consistent with a toxic optic neuropathy. If these eyes happened to be seen during the incipient non-arteritic AION phase, as mentioned above, the optic disc edema may seem to last for much longer than the usual couple of months seen in non-arteritic AION patients first seen with visual loss. That can cause a mistaken impression about the nature of the optic neuropathy.
Patients on Amiodarone therapy not only have cardiovascular risk factors but also are usually on drugs causing arterial hypotension – particularly nocturnal arterial hypotension. It is the combination of these various risk factors that results in development of non-arteritic AION in these patients (see above). Because of the presence of cardiovascular risk factors and because of the use, often, of arterial hypotensive medication, some of them may present with bilateral incipient or frank non-arteritic AION, and that may mislead physicians to attribute the optic neuropathy to Amiodarone therapy.

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