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Permanent retinal damage following massive dapsone overdose

D J Kenner, K Holt, R Agnello

    The British Journal of Ophthalmology
    |October 1, 1980
    PubMed
    Summary
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    A massive dapsone overdose caused permanent vision loss due to retinal necrosis. This rare side effect highlights the severe risks of extreme drug dosages, even in leprosy treatment.

    Area of Science:

    • Ophthalmology
    • Pharmacology
    • Toxicology

    Background:

    • Dapsone (4,4'-diamino, diphenyl sulphone) is a key treatment for tuberculoid leprosy.
    • Long-term dapsone therapy carries known risks, but severe ocular toxicity is rare.

    Observation:

    • A patient on long-term dapsone therapy attempted suicide with a 7.5g overdose.
    • The patient subsequently developed permanent bilateral retinal necrosis.

    Findings:

    • The overdose induced severe hemolytic anemia, methemoglobinemia, and acute renal failure.
    • Retinal damage is hypothesized to result from hypoxemia and red blood cell fragmentation causing vascular occlusion.

    Implications:

    • This case suggests a previously unreported severe ocular side effect of dapsone.

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  • Highlights the critical need for careful dosage monitoring and awareness of potential toxicities in high-dose scenarios.