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Table 1 Synopsis of cases of visual symptoms in digoxin maintenance therapy or digoxin chronic intoxication published in Pubmed, 1974–2006

From: Spectrum of digoxin-induced ocular toxicity: a case report and literature review

References Patient(s) (F = female or M = male, age in years) Digoxin treatment (mg qd unless otherwise specified) Treatment duration Ocular symptoms Precipitating factors Digoxin level (ng/ml) Specific ophthalmologic examination Evolution after stopping digoxin (or, in a few cases, significantly decreasing the dose)
Manninen [12] n = 5
2 M, 3 F, 61–78
0.15–0.75 Several years Indistinct vision of objects None detected 1.3 (n = 1) 2.1–3.2 (n = 4) Ishihara plates: “some degree of difficulty in seeing the plates for green–red vision”b Full resolution at 2 weeks
Volpe and Soave [13] n = 3
2 M, 1 F, 66–82
a a Yellow hue to objects, formed visual hallucinations (animals, people, household objects) a) a
b) Dose increase to 0.375 mg bd
c) a
a) 5.0
b) 6.5
c) 2.7
Not mentionedb Full resolution after drug level corrected
Aronson and Ford [11] n = 10 (experiment on subjects previously published) Not specified in this article Not specified in this article Not specified in this article Not specified in this article Farnsworth-Munsell 100-Hue test (upper limit of normal for colour defect score = 140). “The median colour defect score in toxic patients (212) was significantly higher than that of controls (85), falling to the significantly lower value of 127 after withdrawal of digoxin […] Full resolution
Weleber and Shults [14] M, 70 0.25 four times daily At least several months Glare sensitivity, dimming of vision, silver flashes in the form of rectangles in the right visual field, halos around lights, no yellow vision Concomitant quinidine sulfate administration 3.5 Farnsworth-Munsell 100-Hue error scores: 569 OD, 646 OS
Electrooculogram: high initial light-to-dark ratios (3.50 OD, 3.20 OS)
Electroretinogram: No detectable dark-adapted cone-mediated response (x wave). Light-adapted cone-mediated response (b wave) significantly subnormal and significantly prolonged in implicit time. Dark-adapted rod-mediated b wave significantly subnormal and prolonged in implicit time. Amplitude of the scotopic a wave (corneal negative peak) and bx wave (corneal positive peak) at maximal stimulus intensity subnormal.
Full resolution after 2 weeks
Closson [9] F, 84 0.5 38 months Blue, green and yellow veils floating everywhere, pleasant visions of trees, sun, etc. No color vision impairment. Concomitant hydrochlorothiazide and triamterene prescription for 2 days 2.2 a Full resolution
Chuman and LeSage [15] n = 2
a) M, 79
b) M, 61
a) 0.25 and 0.125 on alternate days
b) 0.125
a a) “Objects appearing more white than usual”
b) Objects were seen as if they were in a fog and colors appeared to be faded
a a) 13.1
b) 6
Farnsworth-Munsell 100-Hue test error score:
a) 497
b) 854
Ishihara plates:
a) 7 errors/failed
b) 14 errors/failed
AOH-R-R plate defects:
a) medium for green–red and blue-yellow
b) strong for red-green and blue-yellow
Merté et al. [16] n = 14, median age 72 years (prospective study comparing subjects with digoxin and digitoxin intoxication) a At least 6 weeks One-third of patients complained about blurry vision, photopsia and impairment of color vision a Median digoxin level 2.98 (2.49–5.4) Farnsworth-Munsell 100-Hue test: median number of errors 170 Significant improvement, follow-up restricted to 8 days
Hobley and Lawrenson [17] F, 36 0.25 3 months Scintillating visual field loss, in attacks each lasting about 20 min. No alteration in color vision a <2 Friedman Visual Field Analyser Mark II:
relative defect of visual field between 15 and 20 degrees in temporal field OD, and between 15 and 20 nasal field OS
Farnsworth-Munsell 100-Hue error score:
20 OD, 84 OS
Ishihara plates: results normal OU
Full resolution
Piltz et al. [18] n = 3
a) F, 88
b) F, 78
c) F, 58 (with retinitis pigmentosa and high myopia)
a) 0.25
b) 0.25
c) 0.25
a) a
b) 2 months
c) a
a) Progressive, generalized “dimming” of vision OU
b) decreased visual acuity bilaterally with snowy vision, obscuring vision of colors
c) “extreme darkness of vision”
a a) 6.1
b) 2.2
c) 4.5
Electroretinogram (ERG)
a) amplitude of dark adapted flash ERG decreased to ~ 20 % of normal OD, and 45 % of normal OS
Goldman perimetry
b) generalized depression of the field and 10-degree relative central scotoma to the I3E isopter OS
Ishihara plates
b) correctly identified only the test plate
(not all tests available for all patients; no specific tests mentioned for patient c)
a) Partial resolution only at 3 months
b) Full resolution at 1 month
c) Full resolution
Butler et al. [19] n = 6
a) F, 76
b) F, 79
c) F, 82
d) M, 75
e) F, 85
f) M, 66
a) 0.25
b) 0.25–0.75
c) 0.25
d) 0.375
e) 0.25
f) 0.25
a a) “Light through vertical blinds”
b) Flashing lights temporally
c) Yellow and white sparks dancing and swirling over whole visual field
d) Flickering in periphery of vision
e) Glare, brightness OD
f) White glare, “snow on grass, trees”, decreased visual acuity and color discrimination
a a) 0.5–1.4
b) 0.5–0.9
c) 0.8
d) 1.4–1.5
e) 0.7
f) 0.2
Electroretinogram cone b-wave explicit time [ms]:
a) 30.0 OD, 28.8 OS
b) 40 OD
c) not done
d) 37.6b
e) 35.4b
f) 36.4 OD, 36.0 OS
Full resolution
Wolin [20] n = 2
a) F, 68
b) F, 63
a a a) Shimmering lights
b) Blurred vision OU
a a) 1.7
b) 1.0
Humphrey automated visual field testing and fluorescein angiography:
a) not mentioned
b) generalized depression OU with greater inferior than superior visual field lossb
a) Full resolution in 2 weeks
b) Partial resolution
Honrubia et al. [21] M, 72 a 2 months Photopsia in the whole visual field a 2.75 Humphrey automated visual field testing: normal (81 points) Farnsworth-Munsell 100-Hue test:
Significant improvement after 3 days
Nagai et al. [22] n = 2
a) M, 72
b) M, 54
a a Severe decrease in visual acuity a a Electroretinogram (ERG):
30 Herz-flicker ERG and photopic ERG: decreased amplitudeb
Gödecke-Koch et al. [23] F, 90 (severe eye disease after bilateral zoster infection) 0.2 a Visual hallucinations (people, yellow hay, colored surfaces) a 1.9 a Full resolution
Oishi et al. [24] F, 72 0.125 1 year Sudden onset of binocular photopsia in the periphery of visual fields Diarrhea with dehydration and hyperkaliemia 1.7 a Full resolution in 2 weeks
  1. OD right eye, OS left eye, OU both eyes
  2. aNo information available
  3. bNo further details or quantification available