Transthyretin amyloid cardiomyopathy (ATTR-CM) can cause a range of eye symptoms, affecting sight and causing discomfort when amyloid deposits build up in the eyes. If vision changes, pain and discomfort occur, an ophthalmologist must be consulted without delay. They may recommend medicine or surgery to manage symptoms and help preserve vision.
Common eye symptoms in ATTR-CM
There are two types of ATTR-CM: wild-type ATTR-CM, which is associated with aging, and hereditary ATTR-CM, which is inherited. Ocular symptoms are found in 10% of hereditary ATTR-CM patients. Symptoms manifest when amyloid deposits accumulate in the ocular tissues such as the corneal endothelium, lens capsule, iris epithelium, vitreous body, conjunctiva and lacrimal glands, among others.
Eye conditions and symptoms may include the following:
- Floaters or vitreous opacities: These are shadows, squiggly lines or threads that float across the field of vision.
- Chronic open-angle glaucoma (COAG): This form of glaucoma can cause severe eye pain and blurred vision, and lead to permanent loss of vision.
- Abnormal conjunctival vessels: Damage to the blood vessels can cause a red spot in the eye, discharge, itching, double vision, blurred vision, pain and light sensitivity.
- Keratoconjunctivitis sicca: Also called dry eye syndrome, this can cause itching, burning, irritation, light sensitivity, excessive eye watering, blurry vision and floaters.
- Corneal neuropathy: Nerve damage can cause pain, dryness, itching and burning, as well as sensitivity to light, wind and temperature.
- Accommodation defects: Problems with the eye’s ability to focus can cause near blurred vision, headaches, difficulty switching between near and far distances, eye fatigue and eye strain.
- Chorioretinal vascular changes: Blood vessel damage can lead to seeing black spots or floaters, red eyes, eye pain, excessive eye watering, difficulty seeing colors and blurred vision.
- Pupillary abnormalities: This can cause headaches, light sensitivity, difficulty focusing and double vision.
- Optic neuropathy or neuritis: This can cause pain when moving your eyes, blurring, blind spots, reduced vision or complete loss of vision.
- Ocular adnexal amyloidosis: This rare condition can cause eyelid swelling, eyelid drooping and bulging eyes.
Read more about ATTR-CM signs and symptoms
Managing eye symptoms in ATTR-CM
Medication for ATTR-CM such as tafamidis manages symptoms and slows disease progression, which generally helps all ATTR-CM symptoms. The following tips can help ease the discomfort of eye symptoms:
- Use artificial tears or eye drops to ease eye dryness.
- Prescription eye drops will boost tear production.
Your eye doctor will help with urgent advice on treatment options for more serious complications — for example, laser therapy to treat chronic open-angle glaucoma (COAG). Floaters, while less serious, can be improved with vitrectomy surgery to remove the vitreous gel and amyloid deposits.
Regular eye exams with your ophthalmologist or retina specialist will allow early detection and treatment, ensuring the best outcomes. Without close monitoring and timely intervention, people living with ATTR-CM risk partial or complete loss of vision.
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