Toxic optic neuropathy: An unusual cause

• Published in: Indian journal of ophthalmology 2014-10, Vol.62 (10), p.1036-1039
• Main Authors: Ramkumar, Hema, Savino, Peter
• Format: Article
• Language: English
• Subjects: Abducens palsy; Acetylcholine; Alcohol; Alcoholism - complications; Atypical optic neuritis; autoimmune; autoimmunity; Automation; Brief Communication; Care and treatment; Case studies; Chemosis; Childhood optic atrophy; Chronic Disease; clinical profile; computed tomography; Cortical visual impairment; cranial nerve palsy; Diagnosis; etiology; Fellowship; Female; Humans; hypoglycemia; hypoxia; Idiopathic intracranial hypertension; India; lumbo-peritoneal shunt; Magnetic Resonance Imaging; Malnutrition; Megadose; methylprednisolone; Middle Aged; mononeuropathy; mouthwash; multiple sclerosis; neuro-muscular junction; neuro-ophthalmology; neuroimaging; neuromyelitis optica; neuroretinitis; ocular myasthenia gravis; ophthalmology; optic atrophy; Optic Nerve - pathology; Optic Nerve Diseases - diagnosis; Optic Nerve Diseases - etiology; optic nerve sheath fenestration; optic neuritis; optic neuropathy; Patients; periventricular leukomalacia; prematurity; pseudotumor cerebri; sixth nerve palsy; steroids; strabismus; sub-specialty; thyroid eye disease; Tobacco; Tomography, Optical Coherence; toxic optic neuropathy; traumatic optic neuropathy; treatment; ventriculo-peritoneal shunt; Vision disorders; Vitamin B
• ISSN: 0301-4738; 1998-3689
• DOI: 10.4103/0301-4738.146045

A 60-year-old woman with a history of chronic alcoholism and tobacco use presented with the complaint of a painless decrease in vision in both eyes. She lost vision first in the left eye then in the right eye. She admitted consuming at least one 16 ounce bottle of over the counter mouthwash daily and denied consumption of any other alcohols, methanol, or antifreeze. She stated that her vision had been continuing to deteriorate in both eyes. Her best-corrected visual acuity was 4/200 in each eye. Color vision was nil in each eye. Her pupils were sluggish bilaterally, and her optic discs were flat and hyperemic with peripapillary hemorrhages. Her visual fields revealed central scotomas bilaterally. The magnetic resonance imaging of the brain and lumbar puncture were within normal limits. Antinuclear antibody, human leukocyte antigen-B27 genotyping, and B12 were normal; serum thiamine was low. While continuing to ingest mouthwash, her vision decreased to count fingers at 2 feet, and maculopapillary bundle pallor developed. She was started on folate and thiamine supplementation. Once she discontinued mouthwash, her vision improved to 20/400 bilaterally, and her central scotomas improved. This case demonstrates an alcohol-induced toxic optic neuropathy from mouthwash ingestion with some visual recovery after discontinuation of the offending agent.