Sertraline-Induced Optic Nerve Dysfunction

This case report describes a rare case of Sertraline-induced optic nerve dysfunction with optic disc edema (papilledema) in both eyes in a 32-year-old male who was on chronic sertraline therapy for the treatment of generalized anxiety disorder and three panic episodes. The patient was presented to our ophthalmology clinic with two bubbles with dark borders in both eyes on the far side for a few months. An optical coherence tomography showed that retinal nerve fiber layer thickness was 98 microns in OD (right eye) and 105 microns in OS (left eye). Another optical coherence tomography findings in both eyes were the elevation of superior and inferior quadrants. Optical coherence tomography findings supported the diagnosis of optic disc edema (papilledema) in both eyes. Magnetic resonance imaging of the brain revealed symmetrical enlargement in the optic nerves (8 mm in diameter at its thickest point). However, abnormal enhancement was absent, excluding optic neuritis. Sertraline was discontinued and replaced by fluoxetine 20 mg. Five months later, papilledema was resolved. On follow-up one month later, the patient continued to improve in terms of symptoms and test results. The case presented demonstrates a rare association between sertraline use and optic nerve dysfunction. Adding to the increasing number of patients using sertraline worldwide, further research is warranted to investigate the incidence of this association and explore possible pathologic mechanisms.