Reversible optic neuropathy associated with Disulfiram: A clinical and electrophysiological report

Neuropathie optique lors d’un traitement par disulfirame

INTRODUCTION

Disulfiram has been used since the late 1940s to treat chronic alcoholism. This drug interferes with alcohol metabolism resulting in an acetaldehyde increase. This causes painful symptoms, encouraging abstinence. Side effects include rare cases of bilateral optic neuropathies. Visual recovery occurs frequently upon cessation of therapy.

METHOD AND OBSERVATION

We retrospectively studied patients referred for visual loss while treated with disulfiram between 1987 and 2005. Fourteen patients (three females, 11 males; aged 35-62 years) complained of visual loss, but a toxic, disulfiram-related, optic neuropathy was diagnosed in only five patients. Following cessation of disulfiram therapy, visual acuity and field improved in all five patients.

DISCUSSION

and conclusion: When disulfiram toxicity is suspected with optic neuropathy, cessation of treatment is mandatory. Visual prognosis is good in the majority of cases, as illustrated by our series. Disulfiram toxicity can be diagnosed only after excluding all other possible causes of visual loss.

Drug-induced toxic reactions in the eye: an overview

Every drug can produce untoward consequences, even when used according to standard or recommended methods of administration. Adverse drug reactions can involve every organ and system of the body, even the eye, and frequently are mistaken for signs of underlying disease. Reactions in the eye may involve the eyelids, periorbital tissues, lacrimal apparatus, conjunctiva, cornea, lens, iris, ciliary body, intraocular pressure, retina, optic nerve, and ocular movement. In addition, fetal abnormalities can be caused by the use of eye drugs during pregnancy. Topical ophthalmic therapies or the use of ophthalmic dyes may cause systemic reactions. This article reviews drugs used systemically or topically that may cause adverse effects in the eye and related structures. Adverse ocular reactions to medications create an important health problem, and nursing professionals in close contact with patients inside and outside the hospital must assume a role in detecting them early, identifying them, educating the patient about them, and treating them.

[Disulfiram (Esperal) toxicity. Apropos of 3 original cases]

Prescribed since 1948 to control chronic alcoholism, disulfiram may cause severe toxicity as report in three cases of acute motive axonal polyneuritis. Disulfiram toxicity may present different clinical aspects: 1) Cytolytic hepatitis with fatal evolution in 30% of cases (fulminant hepatitis), and full recovery for the other 70%. The onset of the symptoms usually occurs as early as 15 days to a maximum of 6 months (most within 2 months) after initiation of treatment. 2) Severe optic neuritis with full recovery in 2 months. 3) Peripheral neuropathy usually dose dependent, with different clinical presentations: polyneuritis with sensory, motor, or both deficits, and few cases of tetraplegia. 4) Encephalopathy frequently associated with one of the precedent symptoms, having a favorable outcome (probably resulting in inhibition of dopamine-beta-hydroxylase by disulfiram). The mechanism of toxicity (direct or idiosyncractic) remain unclear. Disulfiram has been used safely in millions of people since 1948, and we have only few cases reports of severe toxicity. From a practical point of view, treated patients should benefit by a neurological examination once a month, ophtalmological examination every 2 months, and hepatic enzymes monitored twice a month during the 2 first months. This is the price to prevent and to detect side effects of disulfiram therapy.