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An African American woman in her 50s presented for recent-onset blurred vision in both eyes for 2 months. She endorsed mild photophobia but denied pain, redness, tearing, or discharge. There was no history of oral/genital ulcers, rashes, or atopy. Her medical history was significant for hypertension, asthma, hepatitis C, and essential tremor. Her medications include lisinopril, albuterol sulfate, and amantadine hydrochloride. She denied any previous ocular surgical procedures or trauma. She was seen 2 weeks prior and was treated with 400 mg of oral acyclovir sodium 5 times a day and sodium chloride, 5%, ointment 4 times a day. Her central corneal thickness at that time was recorded at 798 μm OD and 827 μm OS.
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Amantadine-associated endothelial toxicity
D. Discontinue treatment with amantadine
Amantadine has been shown in several case reports and studies to cause bilateral corneal edema secondary to endothelial toxicity, which may or may not be reversible.1- 8 Elimination of all potential toxic agents is needed to determine the cause of the endothelial failure and resultant corneal edema. The patient had received 200 mg of amantadine for the past year, with an increase in the dose to 300 mg 7 months ago. It is also important to rule out herpetic disease as a potential cause of endothelial dysfunction. The patient was receiving acyclovir for 2 weeks without improvement in symptoms and had worsening corneal edema.
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Corresponding Author: Ketki Soin, MD, Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, 1855 W Taylor St, Chicago, IL 60612 (firstname.lastname@example.org).
Published Online: November 3, 2016. doi:10.1001/jamaophthalmol.2016.2737
Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
Funding/Support: This work was supported by an unrestricted grant from Research to Prevent Blindness.
Role of the Funder/Sponsor: Research to Prevent Blindness had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Additional Contributions: We thank the patient for granting permission to publish this information.
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