Bitemporal peripapillary hemorrhages: Toxic-ischemic optic neuropathy caused by ethanol and cocaine abuse

A 36-year-old man presented complaining of bilateral painless vision loss. He was admitted with chronic ethanol abuse, as well as sporadic cocaine consumption three days before symptom onset. General medical evaluation dismissed cerebral and cardiovascular events. Blood tests revealed folic acid def...

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Bibliographic Details
Published in:American journal of ophthalmology case reports 2022-03, Vol.25, p.101374-101374, Article 101374
Main Authors: Burggraaf-Sánchez de las Matas, R., Sandino-Pérez, M.L.
Format: Article
Language:English
Subjects:
Drugs abuse
Nutritional deficiency
Peripapillary hemorrhages
Toxic optic neuropathy
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Summary:A 36-year-old man presented complaining of bilateral painless vision loss. He was admitted with chronic ethanol abuse, as well as sporadic cocaine consumption three days before symptom onset. General medical evaluation dismissed cerebral and cardiovascular events. Blood tests revealed folic acid deficiency. Visual acuity (VA) was count fingers in both eyes (OU). Fundoscopic findings included remarkable bitemporal peripapillary hemorrhages. A diagnosis of toxic-ischemic optic neuropathy was made. The hemorrhages resolved after three weeks, with VA recovering to 20/20 OU. The sequelae included bitemporal peripapillary retinal fiber loss on optical coherence tomography, and central scotomas observed on visual field tests. This is the first report of cocaine as a triggering agent for a classical presentation of toxic optic neuropathy and the presence of peripapillary hemorrhages in its initial stages.
ISSN:2451-9936
2451-9936
DOI:10.1016/j.ajoc.2022.101374