Purpose: Disulfiram is an alcohol deterrent for patients with chronic alcohol dependence. We report a case of disulfiram-induced toxic optic neuropathy.
Case: A 62-year-old man with a hist×ory of chronic alcohol dependence was treated using disulfiram for the last 2 years. He was referred to our clinic for a 2-month history of bilateral visual disturbance. Visual acuity at the time of initial examination was 0.1 (0.2) in the right eye and 0.3 (0.4) in the left eye. Critical fusion frequency was 22 and 21 Hz in the right and left eyes, respectively. Static perimetry confirmed the presence of bilateral central cecal scotoma. Fundus examination revealed that the temporal side of the optic disc was slightly pale in both eyes. No abnormality was found on magnetic resonance imaging (MRI). Optical coherence tomography (OCT) indicated a thinning of the retinal nerve fiber layer in the temporal side of optic disc and retinal nerve fiber layer, retinal ganglion cell layer and inner plexiform layer in the macular region of both eyes. Drug-induced toxic optic neuropathy was suspected; therefore, disulfiram was immediately discontinued. After 1 month, his visual symptoms were gradually improved, and at 12 months after disulfiram discontinuation, his visual acuity was finally reached 0.5 (1.2) in the right eye and 0.8 (1.2) in the left eye.
Conclusions: Disulfiram may cause toxic optic neuropathy. The symptom onset could be associated with drug-induced mitochondrial metabolic failure in the retinal ganglion cells.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 126: 1064-1070,2022.