Ramkumar Hema L, Savino Peter J
Department of Ophthalmology, Shiley Eye Center, University of California-San Diego, La Jolla, CA, USA.
Indian J Ophthalmol. 2014 Oct;62(10):1036-9. doi: 10.4103/0301-4738.146045.
A 60-year-old woman with a history of chronic alcoholism and tobacco use presented with the complaint of a painless decrease in vision in both eyes. She lost vision first in the left eye then in the right eye. She admitted consuming at least one 16 ounce bottle of over the counter mouthwash daily and denied consumption of any other alcohols, methanol, or antifreeze. She stated that her vision had been continuing to deteriorate in both eyes. Her best-corrected visual acuity was 4/200 in each eye. Color vision was nil in each eye. Her pupils were sluggish bilaterally, and her optic discs were flat and hyperemic with peripapillary hemorrhages. Her visual fields revealed central scotomas bilaterally. The magnetic resonance imaging of the brain and lumbar puncture were within normal limits. Antinuclear antibody, human leukocyte antigen-B27 genotyping, and B12 were normal; serum thiamine was low. While continuing to ingest mouthwash, her vision decreased to count fingers at 2 feet, and maculopapillary bundle pallor developed. She was started on folate and thiamine supplementation. Once she discontinued mouthwash, her vision improved to 20/400 bilaterally, and her central scotomas improved. This case demonstrates an alcohol-induced toxic optic neuropathy from mouthwash ingestion with some visual recovery after discontinuation of the offending agent.
一名有慢性酒精中毒和吸烟史的60岁女性，因双眼无痛性视力下降前来就诊。她先是左眼失明，随后右眼也失明。她承认每天至少饮用一瓶16盎司的非处方漱口水，否认饮用过任何其他酒类、甲醇或防冻液。她说自己双眼视力一直在恶化。她每只眼睛的最佳矫正视力均为4/200。每只眼睛的色觉均丧失。她双侧瞳孔反应迟钝，视盘扁平且充血，伴有视乳头周围出血。她的视野显示双侧中央暗点。脑部磁共振成像和腰椎穿刺结果均正常。抗核抗体、人类白细胞抗原-B27基因分型及维生素B12均正常；血清硫胺素水平较低。在继续摄入漱口水期间，她的视力下降至只能在2英尺处数指，并且出现了黄斑乳头束苍白。她开始补充叶酸和硫胺素。一旦她停止使用漱口水，她的视力双侧改善至20/400，中央暗点也有所改善。该病例显示因摄入漱口水导致酒精性中毒性视神经病变，停用致病因素后视力有所恢复。
