THE OCULAR EFFECTS OF TOPICAL DIGITALIS

Corneal Endothelial Dysfunction as a Manifestation of Digoxin Toxicity

PURPOSE

The purpose of this study was to report a case of corneal endothelial dysfunction and subsequent corneal edema in a patient with digoxin toxicity.

METHOD

This was a case report.

RESULTS

A 77-year-old woman diagnosed with open-angle glaucoma and treated with a topical prostaglandin analog for 5 years developed blurred vision and photopsia in both eyes. Systemic medications included digoxin, furosemide, apixaban, amlodipine, enalapril, and simvastatin. Ocular examination revealed folds in Descemet membrane and corneal stromal edema in both eyes, with normal fundoscopy. Ancillary tests revealed elevated serum digoxin levels. No intervention other than discontinuation of digoxin was initiated. The corneal edema improved after that and resolved in the next 2 weeks.

CONCLUSIONS

We encountered 1 case of corneal edema secondary to corneal endothelial dysfunction in a patient with digoxin toxicity. Special care should be taken to elicit a complete history because ocular signs can be manifestations of systemic alterations with vital importance for patients.

Acute corneal edema without epithelium compromise. A case report and literature review

El edema de córnea es una entidad que se produce por un gran número de causas y tiene diversas formas de presentación y diferentes grados de afección. En este artículo se reporta el caso de un hombre con edema de córnea agudo sin compromiso epitelial, en el que el cuadro clínico, el examen oftalmológico y los estudios de extensión no lograron establecer su etiología. Además, se hace una revisión de la literatura disponible respecto a todas las posibles causas de edema de córnea agudo, agrupándolas en aquellas que ocasionan el edema por lesión o inflamación epitelial o estromal, por disfunción endotelial o por un aumento en la presión intraocular.

[The influence of systemic digitalis application on intraocular pressure]

The intraocular pressure (IOP) of ten healthy subjects was measured before and after a 2-week systemic application of beta-methyldigoxin. The drug led to a highly significant decrease of IOP of on the average 2 mm Hg. The decrease was independent of the blood concentration of glycoside - at least within the therapeutic range. There was a positive correlation between IOP before digoxin application and the subsequent IOP decrease. The rate of outflow increased, but not significantly. Implications for the therapy of glaucoma are briefly discussed.