J Korean Ophthalmol Soc.  2007 Dec;48(12):1731-1735.

A Case of Toxic Amblyopia Caused by Methanol Intoxication

• Bang JS
• Yang HS
• Rho SS
• Chang YH

Abstract

PURPOSE: To report a case of visual improvement in methanol poisoning treated with intravenous methylprednisolone.
CASE SUMMARY
A 64-year-old man presented with decreasing vision in both eyes after ingesting a car window cleanser. His initial visual acuity was the ability to count fingers in the right eye and hand motion in the left eye. The patient received intravenous methylprednisolone (1.0 gram), slowly over 1 hour. The same dose of methyl prednisolone was repeated on the second and third day. Then, oral prednisolone was given and tapered over a period of 7 weeks. On the 5th day after treatment, there was an improvement in the visual acuity of the right eye to 0.4 but no improvement of vision was observed in the left eye. On 16th day after treatment, the visual acuity was 0.7 in the right eye and counting fingers in the left eye. At 2 months after ingestion, the visual acuity of the right eye returned to 1.0 with no improvement in the left eye. Optic disc pallor was suspected and P100 delay was observed in the left eye with VEP showing a favorable outcome in the right eye.
CONCLUSIONS
A visual improvement of 1 eye was observed in methanol poisoning treated with intravenous methylprednisolone.

Keyword

Amblyopia; Intoxication; Methanol; Steroid

MeSH Terms

Amblyopia*
Eating
Fingers
Hand
Humans
Methanol*
Methylprednisolone
Middle Aged
Pallor
Poisoning
Prednisolone
Visual Acuity
Methanol
Methylprednisolone
Prednisolone

Figure

• 

  Figure 1. At the 4th day after intoxication, the VEP showed no definite P100 delay but amplitude decreased significantly in both eyes.

• 

  Figure 2. At the 8th day after methylprednisolone treatment, the amplitude of VEP improved in the right eye. But no recovery was noted in the left eye. No P100 delay was noted in both eyes.

• 

  Figure 3. At the 2nd month after methylprednisolone treatment, the VEP was normalized in the right eye. But P100 delay and low amplitude was noted in the left eye.

• 

  Figure 4. At the 2nd month after methylprednisolone treatment, the disc of the right eye had no definite abnormality. But the disc of the left eye showed slight pallor.

Reference

References

1. Onder F, Ilker S, Kansu T, et al. Acute blindness and putaminal necrosis in methanol intoxication. Int Ophthalmol. 1998-1999; 22:81–4.

2. Rang HP, Dale MM, Ritter JM. Pharmacology. 4th ed.Edinburgh: Churchill Livingstone;1999. p. 628–9.

3. Becker CE. Methanol poisoning. J Emerg Med. 1983; 2:47.

4. Shukla M, Shikoh I, Saleem A. Intravenous methyl- prednisolone could salvage vision in methyl alcohol poisoning. Indian J Ophthalmol. 2006; 54:68–9.

5. Sodhi PK, Goyal JA, Mehta DK. Methanol induced optic neuropathy:treatment with intravenous high dose steroids. Int J Clin Pract. 2001; 55:599–602.

6. Sharpe JA, Hostovsky M, Bilbao JM, Rewcastle NB. Methanol optic neuropathy: A histopathological study. Neurology. 1982; 10:1093–100.

7. Treichel JL, Murray TG, Lewandowski MF, et al. Retinal toxicity in methanol poisoning. Retina. 2004; 24:309–12.

8. Eells JT, Henry MM, Lewandowski MF, et al. Development and characterization of rodent model of methanol-induced retinal and optic nerve toxicity. Neurotoxicology. 2000; 21:321–30.

9. Martinasevic MK, Green MD, Baron J, Tephly TR. Folate and 10-formyltetrahydrofolate dehydrogenase in human and rat retina: relation to methanol toxicity. Toxicol Appl Pharmacol. 1996; 141:373–81.

10. Barceloux DG, Bond GR, Krenzelok EP, et al. American Academy of Clinical Toxicology Practice guidelines for the treatment of methanol poisoning. J Toxicol Clin Toxicol. 2002; 40:415–46.

11. Pappas SC, Silverman M. Treatment of methanol poisoning with ethanol and hemodialysis. Can Med Assoc J. 1982; 15:1391–4.

12. Lee HK, Hwang BK, Kong SM. 2 Cases of toxic amblyopia caused by acute methanol poisoning. J Korean Ophthalmol Soc. 1982; 23:259–63.

13. Song MS, Yoon BJ. A case of optic atrophy following methanol poisoning. J Korean Ophthalmol Soc. 1989; 30:1021–4.

14. Park HK, Kim MM, Hahn DK. Evaluation of VEP in optic nerve diseases and Amblyopia. J Korean Ophthalmol Soc. 1995; 36:1568–73.