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Toxic Amblyopia

Toxic amblyopia, now more commonly termed toxic optic neuropathy, refers to the development of visual loss as a result of exposure to various toxic substances, such as tobacco, alcohol, and certain drugs. Patients firstly present with dyschromatopsia, followed by painless bilateral and progressive vision loss. The condition is frequently not timely recognized and many patients develop severe and often irreversible changes at the time of diagnosis. A detailed patient history with a physical examination is crucial for initial recognition, whereas advanced imaging and ocular tests are used for confirmation.


Presentation

The term "toxic amblyopia" denotes a visual impairment that stems from the toxic effects of various substances [1] [2] [3] [4]. The term "toxic optic neuropathy" is used to describe the damage to the papillomacular bundle by tobacco, methanol, numerous drugs (amiodarone, ethambutol, linezolid, phosphodiesterase 5 inhibitors, etc.), organic solvents (toluene, ethylene glycol), heavy metals (thallium, mercury, lead), or large amounts of alcohol [2] [5] [6]. Nutritional deficiencies (such as of thiamine, riboflavin, niacin, cobalamin, folic acid) have also been included in the pathogenesis of toxic amblyopia [5]. The clinical presentation almost universally starts with dyschromatopsia, particularly affecting the brightness of red color [3] [4] [5]. Difficulties in distinguishing red from green is also a common complaint [1]. Over the course of weeks to months, the progressive damage leads to the formation of scotomas, bilateral defects in visual acuity, and eventually vision loss [2] [3] [4] [5]. A key feature of toxic amblyopia is the absence of pain during its development [1] [2] [3]. Peripheral vision is spared in most cases, but total vision loss has been reported [3]. Manifestations in extraocular sites, such as polyneuropathy and Wernicke-Korsakoff syndrome, are typically seen in alcoholics [1].

Malnutrition
  • Etiology Toxic cause of amblyopia Poisonous amblyopia poisoning amblyopia and the posterior optic neuritis is often bilateral, often seen in excessive drinking or smoking patients, the former may be the actual cause of malnutrition, and the real tobacco[healthfrom.com]
Diplopia
  • Romania: 1990) 51 (4), 83-88 , 2007 3 2007 Characterization of human retinal vessel arborisation in normal and amblyopic eyes using multifractal analysis S Tălu, C Vlăduţiu, CA Lupaşcu International journal of ophthalmology 8 (5), 996 , 2015 2 2015 Diplopia[scholar.google.fr]
  • […] és atribuïble a una causa orgànica. ambliopia estràbica ambliopia estràbica ambliopia estràbica, n f es ambliopía estrábica en strabismic amblyopia Ambliopia que afecta l'ull estràbic, la imatge del qual és suprimida a nivell cerebral per evitar la diplopia[termcat.cat]
  • Conflicting data with Strabismus (2 competing images) Anisometropia (1 clear, 1 blurred image) Brain suppresses information from the "bad" eye Continued suppression leads to permanent Vision Loss Adults unable to suppress different images Adults experience Diplopia[66.199.228.237]
  • Instead of seeing two different images or double vision (diplopia), the brain suppresses the blurrier image. This suppression can lead to amblyopia.[encyclopedia.com]
Blurred Vision
  • Symptom Poisonous amblyopia symptoms common symptoms a lot of drinking after a sudden ... visual impairment photophobia blind spot on the red and green color can not tell the disuse of amblyopia Blurred vision, photophobia and eye discomfort for days[healthfrom.com]
  • Many people with this condition live each day of their lives with permanently blurred vision. Sufferers of toxic amblyopia are slow to respond to dangers and are much more likely to injure themselves during a fall.[rehab4alcoholism.com]
  • The other is with eye drops that temporarily blur vision. Each day, the child gets a drop of a drug called atropine in the stronger eye. It is also sometimes necessary to treat the underlying cause. This could include glasses or surgery.[medlineplus.gov]
  • These meds and others, like anti-anxiety medications and ADHD drugs, have a plethora of side effects listed on the package insert, such as blurred vision, dizziness, fatigue, headache, and so on.[reviewofoptometry.com]
Photophobia
  • Symptom Poisonous amblyopia symptoms common symptoms a lot of drinking after a sudden ... visual impairment photophobia blind spot on the red and green color can not tell the disuse of amblyopia Blurred vision, photophobia and eye discomfort for days[healthfrom.com]
  • Blurred or dim vision, difficulty in reading, photophobia, and retrobulbar discomfort on moving the eyes are the common presenting complaints. On examination, the patient has bilaterally symmetrical central, centrocecal, or paracentral scotoma.[notesread.com]
  • Atropine use can cause side effects related to the use of this medication: flushing, rapid heart rate, mood changes (uncommon) and photophobia (common) would be examples of side effects occurring with the use of this medication.[eyewiki.aao.org]

Workup

An early diagnosis is imperative in the case of toxic amblyopia, as proper treatment may reverse the damage and save the patient's vision [5] [6]. For this reason, physicians must perform a detailed clinical assessment when evaluating patients with painless and progressive vision loss [3] [4] [5]. Recent or chronic exposure to toxic substances must be checked, together with a proper dietary history, because a significant number of patients with toxic amblyopia will have accompanying nutritional disorders such as Wernicke's encephalopathy or pellagra [1] [5]. A heteroanamnesis can sometimes be useful when alcohol or tobacco toxicity is suspected [5]. Once important pieces of information are gathered, the physician should proceed to the next step of the workup, namely physical examination with an emphasis on the eyes [3] [4] [5]. Evaluation of visual acuity and visual fields, color vision testing, the light reflex (which is present except in severe methanol poisoning), and fundoscopy are sufficient to make an initial diagnosis [1] [3] [5]. Laboratory studies, including a complete blood count (CBC), basic biochemistry tests, and screening for toxic substances (or vitamin deficiencies) are recommended as well [5]. Visual evoked potentials (VEP) and pattern electroretinography (PERG) can be employed to solidify the diagnosis, whereas magnetic resonance imaging (MRI) is the most appropriate imaging modality.

Treatment

  • Treatment A review of treatment of toxic amblyopia Departments: pediatric ophthalmology ophthalmology refractive Treatment: symptomatic treatment rehabilitation treatment supportive treatment Treatment cycle: 7-30 days Cure rate: 5% Commonly used drugs[healthfrom.com]
  • AmblyopiaExpert is a treatment of ... of the treatment of amblyopia in the age of ... Details - Download - Screenshot 3. Captain Lazy Eye 2.1 ... time for treatment of amblyopia. After this golden period ... as possible.[toxic-amblyopia.smartcode.com]
  • Prognosis With prompt treatment, most people with toxic amblyopia recover some of their lost vision.[merckmanuals.com]
  • Toxic Amblyopia Treatment Treatment includes the removal of all toxic substances from the environment and food and changing unhealthy lifestyles into healthy ones. References: 1.[nethealthbook.com]
  • Treatment is avoiding suspected toxic agents and improving nutrition. Etiology Toxic amblyopia is usually bilateral and symmetric.[merckmanuals.com]

Prognosis

  • Prognosis Patients with decreased vision may improve if the cause is treated or removed quickly. Once the optic nerve has atrophied, vision usually does not recover.[merckmanuals.com]
  • Prognosis With prompt treatment, most people with toxic amblyopia recover some of their lost vision.[merckmanuals.com]
  • ‘alcohol amblyopia’ previously or often ‘tobacco-alcohol amblyopia’ _ is in fact just ‘nutritional optic neuropathy’ related to deficiencies of vitamin B and foliate acid. 3 In different studies, it was shown that a supplementation diet improves the prognosis[nature.com]
  • […] contact lenses Cloth over glasses on good eye side Prescrition glasses to blur good eye Atropine (0.5-1%) 1 drop for 2-7 days per week Indicated in noncompliant children Apply to good eye to dilate pupil Prevents accomodation and causes vision blurring Prognosis[66.199.228.237]
  • Prognosis The younger the child, the better the chance for improvement with occlusion and vision therapy. Success in the treatment of amblyopia also depends on the amblyopia's severity, its specific type, and the child's compliance with treatment.[encyclopedia.com]

Etiology

  • Introduction Etiology Prevention Complication Symptom Examine Diagnosis Treatment Basic Nursing Introduction Brief introduction of toxic amblyopia The disease for the optic nerve orbital segment (nipple macular beam) poisoning caused by the vision loss[healthfrom.com]
  • Etiology Toxic amblyopia is usually bilateral and symmetric. Undernutrition and vitamin deficiencies (eg, vitamins B 1 or B 1 2 or folate) may be the cause, particularly in alcoholics. True tobacco-induced amblyopia is rare.[merckmanuals.com]
  • Etiology Bilateral amblyopia is less common than unilateral amblyopia. Bilateral cases are caused by bilateral image blur (anterior visual pathway).[eyewiki.aao.org]
  • But don’t automatically jump to conclusions that a complicated psychophysical etiology is to blame for the patient’s problems.[reviewofoptometry.com]
  • Amblyopia Aka: Lazy eye Definition Poor vision not correctable with eyeglasses No known primary cause (normal Cornea , lens, retina) Epidemiology Prevalence : 2-4% of US Children Occurs in children up to age 6 years Etiologies Strabismus (most common[66.199.228.237]

Epidemiology

  • Hill Butterworth-Heinemann , 22.10.2013 - 352 Seiten 1 Rezension Scientific Foundations of Ophthalmology focuses on scientific grounds of ophthalmology, including anatomy, genetics, pathology, and epidemiology of blindness and blinding diseases.[books.google.com]
  • Amblyopia Aka: Lazy eye Definition Poor vision not correctable with eyeglasses No known primary cause (normal Cornea , lens, retina) Epidemiology Prevalence : 2-4% of US Children Occurs in children up to age 6 years Etiologies Strabismus (most common[66.199.228.237]
Sex distribution
Age distribution

Pathophysiology

  • Hyperopia or Myopia Astigmatism Isometric amblyopia Severe, equal Refractive Error s Deprivation Amblyopia (least common) Congenital Cataract Retinoblastoma Cornea l scarring Vitreous opacity Severe Ptosis Optic atrophy Iatrogenic excessive patching Pathophysiology[66.199.228.237]
  • Pathophysiology Abnormal visual stimulation during the critical period of visual development results in brain damage.[eyewiki.aao.org]

Prevention

  • Prevention Toxicity amblyopia prevention Early detection of abnormal signs, amblyopia children are often in addition to low vision other than the performance, such as strabismus, depending on the material tilted head, squinting or close too close, etc[healthfrom.com]
  • Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets[books.google.com]
  • Prevention Early recognition and treatment of amblyopia in children can help to prevent permanent visual deficits.[encyclopedia.com]
  • Here are some tips in to minimize your alcohol consumption and help prevent eyesight problems. Make a plan : Start cutting down by creating goals to reach, like the number of drinks you want to cut down to and by what date.[belmarrahealth.com]
  • Primary prevention The key to prevention is detection. There are numerous techniques to detect amblyopia, all with varying degrees of specificity, sensitivity, complexity and cost.[eyewiki.aao.org]

References

Article

  1. Prakash J, Ryali V, Srivastava K, Bhat PS, Shashikumar R, Singal A. Tobacco-alcohol amblyopia: A rare complication of prolonged alcohol abuse. Ind Psychiatry J. 2011;20(1):66-68.
  2. Behbehani R, Sergott RC, Savino PJ. Tobacco-alcohol amblyopia: A maculopathy? Br J Ophthalmol. 2005;89:1543–1544.
  3. Sharma P, Sharma R. Toxic optic neuropathy. Indian J Ophthalmol. 2011;59(2):137-141.
  4. Chiotoroiu S, Noaghi M, Stefaniu G, Secureanu F, Purcarea V, Zemba M. Tobacco-alcohol optic neuropathy – clinical challenges in diagnosis. J Med Life. 2014;7(4):472-476.
  5. Grzybowski A, Zülsdorff M, Wilhelm H, Tonagel F. Toxic optic neuropathies: an updated review. Acta Ophthalmol. 2015;93(5):402-410.
  6. Wasinska-Borowiec W, Aghdam KA, Saari JM, Grzybowski A. An Updated Review on the Most Common Agents Causing Toxic Optic Neuropathies. Curr Pharm Des. 2017;23(4):586-595.

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Last updated: 2018-06-22 09:23