Bilateral methanol-induced optic neuropathy following hand sanitizer ingestion

We report a case of a child with bilateral methanol-induced optic neuropathy highlighting the importance of early recognition and possible treatment options.

An 11-year-old female with history of autism spectrum disorder (ASD) and pica presented with a few hours of bilateral "spotty" vision and dizziness. Several hours prior to presentation, the patient ingested an unknown amount of recalled hand sanitizer. The child had normal vision, but dilated exam was notable for mild bilateral optic disc edema. Optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL) showed global thickening in both eyes. Given these findings of end-organ toxicity, the patient was urgently started on hemodialysis.

Pediatric patients with ASD often have co-morbid eating disorders such as pica or avoidant/restrictive food intake disorder (ARFID). This population of patients is especially susceptible to toxic optic neuropathies related to restricted nutritional intake and toxic ingestion. A high clinical suspicion and early recognition is key to prompt treatment and visual recovery.