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Optic neuropathy secondary to perhexiline and amiodarone
  1. Yiran Tan1,2,
  2. Paul Sia1 and
  3. Sumu Simon1
  1. 1South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
  2. 2Discipline of Ophthalmology and Visual Sciences, The University of Adelaide, Adelaide, South Australia, Australia
  1. Correspondence to Dr Yiran Tan; ian.tan1100{at}


Bilateral optic disc swelling is an important clinical sign for potentially life-threatening and sight-threatening conditions, with the most common being raised intracranial pressure and pseudopapillitis. Perhexiline-related and amiodarone-related optic disc swellings are diagnoses of exclusion. This report describes the diagnosis of a man with perhexiline-induced and amiodarone-induced optic neuropathy after extensive investigation consisting of full ophthalmic examination, biochemical screen, temporal artery biopsy, CT, MRI, positron emission tomography and lumbar puncture. There was partial to complete resolution of optic neuropathy following cessation of the causative medication. We postulate that the underlying mechanism of perhexiline toxicity could be mitochondrial dysfunction related. Our case demonstrates that patients treated with perhexiline and amiodarone should be monitored closely for ocular side effects.

  • unwanted effects / adverse reactions
  • neuroopthalmology
  • cardiovascular system

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  • Contributors YT was responsible for obtaining patient consent, acquisition of clinical information, interpretation of data and writing the manuscript. PS was responsible for interpretation of data and guiding construction of manuscript. SS was responsible for conception and design of case report and guiding construction of manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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