Identifying and treating amiodarone-induced corneal deposits: When the heart saves and the cornea speaks

Abstract

Amiodarone remains a mainstay in the treatment of potentially life-threatening cardiac arrhythmias, yet its long-term use is well known to induce cornea verticillata, an epithelial alteration related to intracellular phospholipid accumulation. In most cases these deposits are clinically silent, but some patients may report glare, halos, blurred vision, or ocular discomfort, symptoms that can negatively affect visual quality and, in selected cases, influence treatment adherence, particularly in individuals with severe cardiovascular disease. This mini-review examines the current evidence on the pathophysiological basis, clinical manifestations, and diagnostic features of amiodarone-related corneal changes, with a focus on slit-lamp biomicroscopy and newer multimodal imaging approaches, including in vivo confocal microscopy. Management is considered within a multidisciplinary framework, where ophthalmic findings must be interpreted alongside the often-essential role of amiodarone in cardiac care. Special attention is given to ophthalmic follow-up, symptom-guided management, and patient counseling. By bringing together the perspectives of ophthalmology and cardiology, this review outlines practical strategies to maintain visual comfort without compromising the systemic benefits of antiarrhythmic therapy.

Keywords: Amiodarone; Cornea verticillata; Drug-induced keratopathy; In vivo confocal microscopy; Ocular surface disease; Multidisciplinary management

Core Tip: Amiodarone therapy is classically linked to cornea verticillata, a characteristic epithelial finding detected during routine ophthalmic examination. In many patients, these changes remain asymptomatic, but in some cases they may contribute to glare, halos, or more general visual discomfort, especially when pre-existing ocular surface disease is also present. Slit-lamp biomicroscopy remains the cornerstone of diagnosis, while anterior segment optical coherence tomography and, in selected cases, in vivo confocal microscopy may provide adjunctive structural documentation. Recognizing amiodarone-related corneal findings is clinically important, not only for accurate diagnosis, but also for appropriate patient counseling, symptom-oriented management, and rational follow-up planning.