Bilateral optic nerve swelling occurred in a patient who had other findings typical of amiodarone toxicity. These included verticillate keratopathy, tremor, gait ataxia, and pulmonary fibrosis. Cessation of amiodarone therapy was followed by slow resolution of optic nerve swelling over 6 months; however, generalized constriction of the visual fields persisted. Several proposed mechanisms of optic nerve swelling secondary to amiodarone toxicity are discussed. Corroborative evidence in the literature suggests the possibility of a unique type of toxic optic neuropathy in this patient.