|Year : 1964 | Volume
| Issue : 1 | Page : 27-28
A case of alcohol amblyopia
Military Hospital, Jabalpur, India
|Date of Web Publication
Military Hospital, Jabalpur
Source of Support: None, Conflict of Interest: None
|How to cite this article:
Balakrishnan E. A case of alcohol amblyopia. Indian J Ophthalmol 1964;12:27-8
Amblyopia is often caused by illicit drinks which contain methylalcohol. In the absence of a genuine history the ophthalmologist has to rely on the symptoms and fundus appearance. The following is an interesting case of alcohol amblyopia treated and followed up for two years.
A male aged 54 years was admitted in the Govt. Ophthalmic Hospital, Madras for sudden loss of vission in both eyes of one day's duration. On the previous night he complained of pain in the abdomen and vomited twice. The following morning he could not see. On examination;
Right eye vision was perception of light only. Left eye vision was hand movements.
Both pupils were dilated and reacted very feebly to light.
Fundus appearence : -both optic discs were hyperemic, margins blurred with peripapillaryoedema. Arteries were uniformly narrowed but the arterio-venous crossings were normal. Blood pressure 120/80. Urine analysis : normal. The general condition was good.
The history of rapid loss of vision, the narrowing of arteries without nipping of veins at 'the arterio-venous crossings, made the author suspect alcohol amblyopia. So a detailed history was elicited through the wife of the patient who coaxed her husband to confess the truth in the interest of treatment. It was as follows; on the night of 21-2-1960 he took an ounce of an illicit drink which was sold to him secretly. On the next morning he noticed that his right eye vision was defective. Again on 22-2-1960 he took about two ounces of the same drink. He had severe abdominal pain and vomited twice in the night. On the following morning he could not see, when he was admitted.
Before the correct history was elicited, he was given priscol one ampule intramuscularly, Berin, vit B 12 intramuscularly and Delta cortil 5 mg twice a day by mouth. On the following day when the correct history was available the following treatment was started:
A C T H 20 units with Nicotinic Acid 50 mgm mixed in one pint of glucose saline and given by an intravenous drip. It was continued for eighteen days with frequent check of eosinophile count and other usual precautions.
On the sixth day of starting this treatment vision improved to 6/18 in the right in eye and 6/6 in the left. On the eighteen day vision in both eyes improved to 6/6, pupils, were still dilated but sluggishly reacted to light. Fundus appearance both the optic discs were pale and the arteries were slightly narrowed. Field chart No. (1) is attached. Patient was discharged with an advice to take Nicotinic Acid 50 mgm twice a day until he was asked to stop. His vision was checked up once a fortnight. After six months his vision had continued to be 6/6 in both eyes. Fundus: typical primary Optic atrophy, and the fields were narrower than before. (field chart no. (2))
At the end of two years his central vision continued to be normal inspite of primary optic atrophy, and the fields have remained contracted as before. The patient continued the oral therapy of Nicotinic acid inspite of the advice to stop it after one year.
Frank Walsh says: "In the United States many cases of poisoning from methyl alcohol were seen during the prohibition era when it or denatured alcohol were consumed either knowingly or accidentally." This applies equally to our country also.
In this case the diagnosis was made on fundus appearence supported by the history of having taken illicit alcohol drink. In the prohibited areas it is very difficult to get the true history. However the history of abdominal pain and vomiting should make an ophthalmologist suspect this condition. Lindsea Rea noted the history of vomiting and abdominal pain in all his cases of alcohol amblyopia. The point of interest in this case was restoration of central vision inspite of primary optic atrophy and the continued contraction of visual fields. It was followed for two years with frequent check up and the condition remained same.
A case of amblyopia due to drinking of illicit alcohol was treated successfully and followed for two years. Even though the central vision was restored the field of vision became contracted.
[Figure - 1], [Figure - 2]