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Int Ophthalmol (2011) 31:517524 DOI 10.1007/s10792-011-9492-2
CASE REPORT
Methanol poisoning: two case studies of blindness in Indonesia
P. Koehrer C. Creuzot-Garcher Alain M. Bron
Received: 5 October 2011 / Accepted: 28 November 2011 / Published online: 27 December 2011 Springer Science+Business Media B.V. 2011
Abstract We report two recent cases of methanol intoxication in French patients living in Bali. These intoxications were secondary to the consumption of adulterated liquor. Both patients presented acute bilateral loss of vision a few days after methanol ingestion with no sign of recovery. The fundus showed bilateral optic atrophy that was well correlated with retinal nerve bre layer thickness measured with spectral-domain optical coherence tomography and compatible with toxic optic neuropathy. In one of the patients, macular swelling in one eye was observed. Electroretinograms were normal contrasting with abolished visual evoked potentials. Methanol was isolated from a sample of the beverage with gas chromatography. Methanol intoxication may occur in Asia and therefore adequate information for tourists and the local population is required.
Keywords Methanol intoxication Optic
neuropathy
Introduction
Methanol was one of the most notorious causes of toxic optic neuropathy in the early twentieth century,
but nowadays this intoxication has become rare in developed countries, although it remains frequent in other areas. We report two recent cases of methanol intoxication in European patients living in Indonesia. The clinical aspects, the physiopathology and the treatment of this intoxication are then discussed.
Case 1
Patient 1, a 37-year-old scuba-diving instructor living in Bali, was admitted to our unit for acute bilateral loss of vision. He had no particular past medical history; however, he declared regular consumption of alcohol and cannabis.
The clinical history started at the beginning of May 2010, with visual symptoms such as photopsia, blurred vision associated with abdominal pain and diarrhoea, followed by bilateral loss of visual acuity a few days later. There was no fever or retrobulbar pain. In Bali, the fundus showed a bilateral papilloedema. A cerebral tomodensitometry performed there was normal and the patient was treated with intravenous pulses of methylprednisolone 1 g per day for 3 days. He was then referred to our unit in France where, almost 10 days after the rst symptoms appeared, a neurological examination found extra-lemniscal hypoesthesia along the left leg...