Electrophysiological assessment of nutritional optic neuropathy: a case report

Abstract

Purpose To report an unexpectedly asymmetric, progressive nutritional optic neuropathy associated with vitamin A deficient optic canal hyperostosis in a 15-year-old female with a long history of a restricted diet. Methods We performed comprehensive ophthalmic assessments in a fifteen-year-old female with a long history of restricted eating who presented with suspected nutritional optic neuropathy, predominantly affecting the right eye vision. Results A review of computerised tomography and magnetic resonance imaging revealed bilateral optic canal hyperostosis likely associated with vitamin A deficiency. Electrodiagnostic tests and optical coherence tomography provided structure–function evidence of bilateral retinal ganglion cell dysfunction and notably revealed severe loss of temporal fibres in the left eye which showed cecocentral scotoma but normal visual acuity. Although selective damage of the papillomacular bundle has been well-documented in nutritional and toxic optic neuropathies, compressive optic canal hyperostosis secondary to nutritional deficiency has been rarely reported. Conclusions Nutritional deficiencies are increasing in high-income countries and may be linked to the rise of gastrointestinal disorders, strict vegan and vegetarian diets and avoidant restrictive food intake disorder (ARFID) associated with conditions such as depression and autism spectrum syndrome (ASD). Our findings highlight the value of electrodiagnostic testing alongside imaging in complex nutritional optic neuropathies to help monitor, guide treatment and preserve remaining sight in a child.

Avoidant-restrictive food intake disorder and autism: epidemiology, etiology, complications, treatment, and outcome

“…Being autistic did not independently predict inadequate nutrition, but having a dual diagnosis did [6 ▪▪ ]. Because individuals with co-occurring ARFID and autism are particularly vulnerable to serious complications [22–29], enteral nutrition is particularly recommended for these individuals [6 ▪▪ ].…”

“…These include nutritional deficiencies [22], particularly vitamin C deficiency [22][23][24] and vitamin A, B12, E, and zinc deficiency [25]. In some situations, complications can be extreme, including osteopenia and compression fractures [25], severe undernutrition [26], acute intestinal pseudoobstruction (Ogilvie's syndrome) [26], optic neuropathy [27], rhabdomyolysis [28], pancytopenia [29], and cardiac arrest [24].…”

Recent Advances in Dietary Sources, Health Benefits, Emerging Encapsulation Methods, Food Fortification, and New Sensor-Based Monitoring of Vitamin B12: A Critical Review

“…The deterioration of the optic nerve in cases of VB 12 deficiency is believed to occur primarily through degenerative processes. Nevertheless, instances of optic neuritis, albeit rare, have been documented as a potential consequence of VB 12 deficiency [68]. Ata et al highlighted that the deficiency of VB 12 can lead to optic neuropathy as an initial manifestation.…”