Toxic Optic Neuropathy Caused by Chlorfenapyr Poisoning
10.3341/jkos.2018.59.11.1097
- Author:
Su Jin PARK
1
;
Jae Uk JUNG
;
Yong Koo KANG
;
Bo Young CHUN
;
Byeong Jae SON
Author Information
1. Department of Ophthalmology, School of Medicine, Kyungpook National University, Daegu, Korea. supersbj@daum.net
- Publication Type:Case Report
- Keywords:
Central nervous system involvement;
Chlorfenapyr poisoning;
Toxic optic neuropathy
- MeSH:
Adult;
Brain;
Brain Stem;
Central Nervous System;
Corpus Callosum;
Eating;
Female;
Fingers;
Ganglion Cysts;
Gastric Lavage;
Hand;
Humans;
Internal Capsule;
Magnetic Resonance Imaging;
Middle Cerebellar Peduncle;
Mouth;
Nerve Fibers;
Optic Atrophy;
Optic Nerve;
Optic Nerve Diseases;
Poisoning;
Pupil;
Pupil Disorders;
Retinaldehyde;
Suicide;
Therapeutic Irrigation;
Tomography, Optical Coherence;
Visual Acuity;
White Matter
- From:Journal of the Korean Ophthalmological Society
2018;59(11):1097-1102
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: To report a case of toxic optic neuropathy caused by chlorfenapyr ingestion accompanied by central nervous system involvement. CASE SUMMARY: A 44-year-old female visited our clinic complaining of reduced visual acuity in both eyes for 7 days. She had ingested a mouthful of chlorfenapyr for a suicide attempt 2 weeks prior to the visit. Gastric lavage was performed immediately after ingestion at the other hospital. Her best-corrected visual acuity was finger count 30 cm in the right eye and hand motion in the left eye. Both pupils were dilated by 5.0 mm and the response to light was sluggish in both eyes. A relative afferent pupillary defect was detected in her left eye. Funduscopy revealed optic disc swelling in both eyes. Magnetic resonance imaging of the brain showed a symmetric hyper-intense signal in the white matter tract including the internal capsule, corpus callosum, middle cerebellar peduncle, and brainstem. The patient was diagnosed with toxic optic neuropathy induced by chlorfenapyr ingestion, and underwent high-dose intravenous corticosteroid pulse therapy. Three days later, the best-corrected visual acuity was no light perception in both eyes. Three months later, optic atrophy was observed in both eyes. Optical coherence tomography revealed a reduction in the thicknesses of the retinal nerve fiber layer and ganglion cell and inner plexiform layer in the macular area. CONCLUSIONS: Ingestion of even a small amount of chlorfenapyr can cause severe optic nerve damage through the latent period, despite prompt lavage and high-dose steroid treatment.
