Reversible blindness associated with alcoholic ketoacidosis: pseudomethanol intoxication

We report a case of reversible blindness associated with severe acidosis. A 49-year-old female presented with sudden onset of bilateral blindness. A work up for possible etiologic factors including computed tomography failed to reveal any abnormalities except for ethanol induced severe ketoacidosis. Methanol was not detectable in the serum despite an ethanol level of 14.76 mmol/L, effectively ruling out the diagnosis of methanol intoxication. Treatment of the acidosis led to rapid resolution of her blindness. Review of the literature revealed two case reports of reversible blindness associated with severe acidosis in diabetics. The current case underscores the necessity for a clear understanding of the role of severe acidosis as the sole causative factor of reversible bilateral blindness.