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| |  A Case of Diplopia Apparently Caused by Atorvastatin: Presented at AACE By Maggie Schwarz WASHINGTON, DC -- May 24, 2005 -- Treatment with the cholesterol-lowering agent atorvastatin was the culprit behind a case of diplopia reported in one patient, researchers said here May 19th at the American Association of Clinical Endocrinologists (AACE) 14th Annual Meeting and Clinical Congress. "Atorvastatin appeared to cause an eye muscle disorder without myopathy in a patient of ours," said Niti Agarwal MD, a fellow in clinical endocrinology at Lady Hardinge Medical College and Associated Hospitals in New Delhi, India. The case Dr. Agarwal described was that of a 50-year-old diabetic, hypertensive, hyperlipidemic man who developed diplopia within 3 months of starting atorvastatin 10 mg. It resolved within 4 weeks then resurfaced when atorvastatin was reintroduced. The patient had been taking losartan and gliclazide; his hypertension and diabetes were adequately controlled. He complained of binocular diplopia 3 months after starting atorvastatin. Ophthalmic examination was negative for any obvious ocular muscle palsy or muscular tenderness. His pupils were normal in size and reaction. Diabetic neuropathy was ruled out due to the absence of any specific ocular muscle weakness. Serum creatine kinase and lactate dehydrogenase were not raised. Within 4 to 6 weeks of stopping atorvastatin, the patient's vision improved with no residual diplopia. The patient was rechallenged with atorvastatin 3 months later, whereupon the diplopia recurred. After stopping atorvastatin again, diplopia ceased. The patient then refused further treatment with any statin. Statin-induced myotoxicity is well established, varying in severity from mild myopathy to fatal rhabdomyolysis, with or without an increase in creatine kinase levels. Although statin-associated myasthenia-like symptoms have been reported, statin-induced isolated ocular muscle toxicity has not. Whether ocular muscle involvement is a class effect or specific to atorvastatin is unknown. "Our patient was faced with difficulty driving while experiencing diplopia," said Dr. Agarwal. "Diplopia can have serious consequences."
[Presentation title: Atorvastatin-Induced Isolated Ocular Myopathy.]
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