Burggraaf-Sánchez de Las Matas R, Sandino-Pérez M L
Department of Glaucoma, Ophthalmology, University General Hospital of Castellón, Avenida de Benicàssim, 128, 12004, Castellón de La Plana, Spain.
Department of Ophthalmology, University General Hospital of Castellón, Avenida de Benicàssim, 128, 12004, Castellón de La Plana, Spain.
Am J Ophthalmol Case Rep. 2022 Feb 3;25:101374. doi: 10.1016/j.ajoc.2022.101374. eCollection 2022 Mar.
A 36-year-old man presented complaining of bilateral painless vision loss. He was admitted with chronic ethanol abuse, as well as sporadic cocaine consumption three days before symptom onset. General medical evaluation dismissed cerebral and cardiovascular events. Blood tests revealed folic acid deficiency. Visual acuity (VA) was count fingers in both eyes (OU). Fundoscopic findings included remarkable bitemporal peripapillary hemorrhages. A diagnosis of toxic-ischemic optic neuropathy was made. The hemorrhages resolved after three weeks, with VA recovering to 20/20 OU. The sequelae included bitemporal peripapillary retinal fiber loss on optical coherence tomography, and central scotomas observed on visual field tests. This is the first report of cocaine as a triggering agent for a classical presentation of toxic optic neuropathy and the presence of peripapillary hemorrhages in its initial stages.
一名36岁男性因双侧无痛性视力丧失前来就诊。他因长期酗酒入院，且在症状出现前三天有偶尔吸食可卡因的情况。全面的医学评估排除了脑部和心血管疾病。血液检查显示叶酸缺乏。双眼视力均为手动。眼底检查发现显著的双颞侧视乳头周围出血。诊断为中毒性缺血性视神经病变。三周后出血消退，双眼视力恢复至20/20。后遗症包括光学相干断层扫描显示双颞侧视乳头周围视网膜纤维缺失，以及视野检查发现中心暗点。这是首例关于可卡因作为中毒性视神经病变典型表现的触发因素及其初期视乳头周围出血的报道。
