Case Report: Nutritional and Toxic Optic Neuropathy: A Diagnostic Dilemma
| Autor: | Carolina García-Villanueva, Lidia Remolí-Sargues, Enrique Cervera-Taulet, Miguel Ortiz-Salvador, Lucía Mata-Moret, Clara Monferrer-Adsuara |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Pediatrics medicine.medical_specialty Visual acuity genetic structures Visual impairment Visual Acuity Vision Low Folic Acid Toxic Optic Neuropathy medicine Humans Thiamine Papilledema Depression (differential diagnoses) medicine.diagnostic_test business.industry Smoking Middle Aged medicine.disease eye diseases Visual field Nutrition Disorders Ophthalmology Alcoholism Vitamin B 12 Visual field test Optic nerve Visual Field Tests Macrocytic anemia medicine.symptom Visual Fields business Optometry |
| Zdroj: | Optometry and vision science : official publication of the American Academy of Optometry. 97(7) |
| ISSN: | 1538-9235 |
| Popis: | Significance Nutritional and toxic optic neuropathies are rare disorders characterized by visual impairment due to optic nerve damage by a toxin, usually with coexisting nutritional deficiencies. Its pathophysiology is still unclear, and multiple mechanisms implicated act synergistically to bring about this condition. The decline in its incidence and its confusing clinical appearance make diagnosing nutritional and toxic optic neuropathies challenging. Purpose This is an observational clinical case report of an atypical clinical case of a nutritional and toxic optic neuropathy with a subacute presentation and papilledema at the time of diagnosis. The patient provided written informed consent for medical information and images to be published. Case report A 47-year-old man presented with progressive, painless bilateral decrease in central vision over 15 days. The patient had a long-standing history of alcohol abuse and was a heavy smoker. The examination revealed dyschromatopsia, 20/400 visual acuity on both eyes, and no relative afferent pupillary defect. Funduscopy revealed bilateral papilledema. A visual field test showed generalized depression with centrocecal involvement in the left eye. Laboratory studies evidenced decreased vitamin B12/B1 and red blood cell folate levels, increased acute phase reactants, hypertransaminasemia, and macrocytic anemia. Serologies and methanol in urine were negative. After the discontinuation of tobacco use and alcohol accompanied by vitamin supplementation, our patient's visual field, visual acuity, and papilledema improved remarkably. After 5 months, visual acuity and funduscopy were normal. Conclusions Although some hallmark signs were visible in this case, its subacute presentation and the presence of papilledema at diagnosis caused some diagnostic uncertainty. Nutritional and toxic optic neuropathy is a rare and challenging diagnosis because of a lack of biomarkers. Eye care clinicians should consider nutritional and toxic optic neuropathies to prevent severe and irreversible visual damage resulting from underdiagnosis and mismanagement. |
| Databáze: | OpenAIRE |
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