Ocular manifestations - an often ignored part in Methanol toxicity

"This 49-year-old male was sent to a municipal hospital because of sudden loss of consciousness for 1 day. At the emergency room, he was unresponsive with shallow respiration. He was intubated immediately and put on mechanical ventilation. Blood gas and biochemical analyses revealed severe metabolic acidosis (pH 6.8, HCO3 7 mEq/l), elevated liver enzymes and ammonia. Brain computed tomography images were unremarkable at that time. Initially, he was treated for metabolic acidosis. Under the impression of methanol intoxication, he underwent emergent haemodialysis. On the fourth day following exposure, blood methanol level was reported to be extremely high (811 mg/dl). The patient was transferred to our hospital for further management.......

He had had headache, nausea, vomiting, general weakness, visual disturbance, and shortness of breath 1 day before his admission. All the above symptoms occurred several hours after drinking an unknown amount of home-made herbal wine, which he obtained from a friend. He was successfully weaned from the respirator at our hospital. However, impaired consciousness, total blindness, and poor movement of his extremities were noted. An electroencephalogram showed diffuse cerebral dysfunction, compatible with the diagnosis of metabolic encephalopathy. The initial fundoscopic examination in both eyes showed moderately swollen, hyperaemic optic disc and dilated, unresponsive pupillary reflex. Visual-evoked potentials revealed marked suppression without identified waveform. Brain MRI performed on day 15 demonstrated multifocal necrosis in the bilateral putamen and frontal and occipital subcortical white matter regions, and marked perifocal vasogenic brain oedema. Intravenous corticosteroids were administered, initially with 300 mg hydrocortisone, and then 100 mg every 6 h. Intravenous osmotic diuretics were also used with 10% 300 ml glycerol every 8 h. Over the following 3–4 days, his consciousness gradually recovered, he became alert, and his motor function steadily improved. However, total blindness in both eyes persisted."


Read full report and discussion here:  C-S Yang, W-J Tsai and J-F Lirng - Ocular manifestations and MRI findings in a case of methanol poisoning - Eye (2005) 19, 806–809

Link: http://www.nature.com/eye/journal/v19/n7/full/6701641a.html