Acute ellipsoid zone thickening: A sign of probable digoxin toxicity?

Abstract

A 62-year-old gentleman presented with blurred vision in both eyes associated with excessive sleepiness and headache for 5 days. Optical coherence tomography (OCT) showed thickening of ellipsoid zone (EZ) with subtle separation from retinal pigment epithelium in both eyes. Patient was on digoxin 0.25 mg once daily for the past 2 years. As OCT was suggestive of photoceptor involvement, we sought an opinion from the cardiologist to consider withholding digoxin. Patient reported visual improvement at 1 week. At 6 months, OCT showed normalization of EZ. We propose that acute EZ thickening would be a sign of digoxin toxicity.