Methanol-induced vision loss

Accidental or purposeful consumption of small amounts of methanol can lead to severe vision loss or death. Vision loss is rapid--usually symmetric--and most often affects the central (or centrocecal) visual field, although peripheral visual loss may occur as well. Fixed, dilated pupils and optic atrophy, with or without excavation, are the most common findings in persons with methanol-induced vision loss.

A 35-year-old man was examined after consuming methanol in the form of windshield wiper fluid. Despite relatively rapid treatment for the patient's methanol poisoning and associated metabolic acidosis, permanent, severe vision loss with associated optic neuropathy developed. Because of the finding of fixed, dilated pupils on the patient's initial presentation, severe vision loss was an expected result for this patient.

Prompt recognition and proper medical treatment are the main factors in successful management of methanol poisoning. Even if proper and timely medical response is achieved, however, the patient may still experience permanent neurologic sequelae or death. Notably, pupillary status may provide the best prognostic information for both morbidity and mortality.