Amantadine Corneal Toxicity: Case Report and Review of the Literature

To report a case of bilateral corneal edema in a patient with a history of cocaine abuse and bipolar-depression treated with amantadine for 6 months, and to review the literature on amantadine corneal toxicity.

The clinical record of a patient with amantadine corneal toxicity and the existing literature on this subject were extensively reviewed for prevalence, clinical presentation, pathogenesis and therapy.

A 27 year-old male who suffered from depression and cocaine abuse presented with sudden visual loss (20/150 OD and 20/200 OS) caused by bilateral corneal stromal edema without ocular inflammation. Corneal edema was related to amantadine therapy (200 mg per day) for 6 months. Visual acuity improved to 20/20 OU and corneal edema resolved after one month of cessation of therapy. Corneal endothelial cell density after3 months of discontinuation of amantadine therapy was 636 ± 359 cells/mm² in the right eye and 1,176 ± 238 cells/mm² in the left eye. There was also increased pleomorphism (45.3% 6A cells OD, 56.4% 6A cells OS) and polymegatism (coefficient of variation, 39.04 ± 6.38 OD and 34.76 ± 2.68 OS).