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Toxic optic neuropathy: an unusual cause.

Hema L Ramkumar, Peter J Savino1

  • 1Department of Ophthalmology, Shiley Eye Center, University of California-San Diego, La Jolla, CA, USA.

Indian Journal of Ophthalmology
|December 3, 2014
PubMed
Summary

Ingesting over-the-counter mouthwash daily caused toxic optic neuropathy in a patient with alcoholism. Discontinuing mouthwash led to vision improvement, highlighting the dangers of alcohol-based products.

Area of Science:

  • Ophthalmology
  • Toxicology
  • Neurology

Background:

  • Chronic alcoholism and tobacco use are risk factors for various health issues.
  • Toxic optic neuropathies can result from ingestion of certain substances.
  • Mouthwash, often containing ethanol, can be misused as an alcohol source.

Observation:

  • A 60-year-old woman presented with painless, progressive vision loss in both eyes.
  • She reported daily consumption of a 16-ounce bottle of over-the-counter mouthwash.
  • Clinical examination revealed decreased visual acuity, nil color vision, sluggish pupils, optic disc hyperemia with hemorrhages, and bilateral central scotomas.

Findings:

  • Serum thiamine levels were low, and magnetic resonance imaging of the brain and lumbar puncture were normal.

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  • Vision further deteriorated with continued mouthwash ingestion, leading to maculopapillary bundle pallor.
  • Discontinuation of mouthwash and supplementation with folate and thiamine resulted in partial visual recovery and improvement of central scotomas.

    • Implications:

    • This case highlights alcohol-induced toxic optic neuropathy secondary to intentional mouthwash ingestion.
    • It underscores the potential for systemic toxicity from commonly available over-the-counter products.
    • Early identification and cessation of the offending agent are crucial for visual recovery in toxic optic neuropathies.