40 years old man has glare in both eyes. Examination revealed whorl like opacities of corneal epithelium. He gives history of long term treatment with amiodarone. What is the MOST likely diagnosis?
**Core Concept:** Amiodarone is a broad-spectrum antiarrhythmic drug used to treat certain types of heart rhythm disorders. It is a medication with numerous side effects, including corneal opacities due to its accumulating in the cornea and leading to epitheliopathy.
**Why the Correct Answer is Right:** The patient's symptoms and examination findings (whorl-like opacities in the corneal epithelium) are consistent with amiodarone-induced corneal epitheliopathy. Amiodarone is a known cause of this condition, which results from the drug's accumulation in the cornea.
**Why Each Wrong Option is Incorrect:**
A. Dry eyes: While amiodarone can cause dry eyes, the whorl-like opacities in the corneal epithelium are more consistent with the diagnosis of corneal epitheliopathy.
B. Corneal ulcers: Corneal ulcers are characterized by redness, pain, and discharge rather than the described whorl-like opacities in the corneal epithelium.
C. Refractive errors: Corneal epitheliopathy is not related to refractive errors but rather to the specific side effect of amiodarone.
D. Other medications: While other medications can cause corneal opacities, the whorl-like appearance is specific to amiodarone-induced corneal epitheliopathy.
**Clinical Pearl:** Amiodarone-induced corneal epitheliopathy is a well-known side effect that should be considered in patients taking amiodarone who present with corneal opacities, even if they have dry eyes or a history of prolonged amiodarone use.
**Correct Answer:** D. Other medications (specifically mentioning amiodarone)
**Explanation:** In this case, the patient presents with symptoms and examination findings consistent with corneal epitheliopathy, a side effect of amiodarone. While other medications can cause corneal opacities, the whorl-like appearance is specific to amiodarone-induced corneal epitheliopathy. Therefore, the correct answer is option D (Other medications) specifically mentioning amiodarone.