Antipsychotic Seroquel user has sudden vision loss

Branch retinal vein occlusion associated with quetiapine fumarate:

Abstract

Background
To report a case of branch retinal vein occlusion in a young adult with bipolar mood disorder treated with quetiapine fumarate.

Case Presentation
A 29 years old gentleman who was taking quetiapine fumarate for 3 years for bipolar mood disorder, presented with sudden vision loss. He was found to have a superior temporal branch retinal vein occlusion associated with hypercholesterolemia.

Conclusion
Atypical antipsychotic drugs have metabolic side effects which require regular monitoring and prompt treatment.

Background

Retinal vein occlusions (RVOs) frequently occur in the elderly in association with atherosclerosis. Hypertension is the commonest cause of RVOs in such population. In young adults, RVOs are associated with vasculitis and coagulopathies. Extensive work-up is required as both vasculitis and coagulopathies can lead to severe systemic morbidity and mortality. We describe a case of branch retinal vein occlusion in a young adult who has been taking quetiapine fumarate* for 3 years. (*Seroquel)

Case Presentation

A 29 years old gentleman was referred from the emergency department with the complaint of sudden painless vision loss of his left eye for the past 1 week. Since onset, he experienced progressive generalized blurring of the central vision. There was neither photopsia nor floaters. Systemic review was not significant. He has no symptoms and signs of systemic vasculitis such as rashes, joint pains or mucosal surface ulcers. He was diagnosed of bipolar mood disorder in 2008, and was treated with oral quetiapine fumarate 100 mg daily. His bipolar mood disorder responded well to quetiapine fumarate without any side effects. Sexual history was not significant and he has no history of substance abuse or smoking. There was no family history of vascular events as well.

He was a medium built individual with a body mass index of 24.83 kg/m2 (height 165.5 cm, body weight 68 kg). His body weight prior to quetiapine treatment was 62 kg. Blood pressure was 122/74 mmHg with a regular pulse rate of 80 beats per minute. The visual acuity of his left eye was 0.33, with near visual acuity of N24 at 33 cm. The right eye had visual acuity of 1.0 and near vision of N6 at 33 cm. Confrontation test revealed a left central scotoma. Relative afferent pupillary defect was absent. Anterior segment examination for both eyes was normal. The intraocular pressure was 16 mmHg bilaterally.


AND

The patient was diagnosed to have left major superior temporal branch retinal vein occlusion complicated by macula oedema. The cause of the RVO was attributed to dyslipidaemia secondary to quetiapine fumarate. The condition was conveyed to his psychiatrist, and he was subsequently referred to the internist for the management of his dyslipidaemia. The patient was treated with oral lovastatin 20 mg daily. His lipid profile normalized after 2 months but the final visual acuity remained 0.33 and near visual acuity N24 at 33 cm due to the presence of hard exudates at the fovea.

Conclusions

RVOs in young adults require careful systemic evaluation for the presence of cardiovascular risk factors as well as to exclude hypercoagulabilities or collagen vascular diseases. The usage of antipsychotics medications require regular monitoring and prompt intervention for any metabolic side effects and adverse drug reactions."



Go ahead and use this off-label for insomnia, or let a doctor put your child on it...no worries, right?