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

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 mentioned^b

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

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

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

^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

^a

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

3 months

Scintillating visual field loss, in attacks each lasting about 20 min. No alteration in color vision

^a

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) 37.6^b

e) 35.4^b

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 loss^b

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

Humphrey automated visual field testing: normal (81 points) Farnsworth-Munsell 100-Hue test:

normal

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 amplitude^b

^a

Gödecke-Koch et al. [23]

F, 90 (severe eye disease after bilateral zoster infection)

^a

Visual hallucinations (people, yellow hay, colored surfaces)

^a

^a

Full resolution

Oishi et al. [24]

F, 72

1 year

Sudden onset of binocular photopsia in the periphery of visual fields

Diarrhea with dehydration and hyperkaliemia

^a

Full resolution in 2 weeks