Tobacco-alcohol amblyopia: a maculopathy?

Abstract

Bilateral naevus of Ota with choroidal melanoma and diffuse retinal pigmentation in a dark skinned person Naevus of Ota (naevus fusculocoeruleus ophthalmomaxillaris) was described by the Japanese dermatologist, Ota, in 1939 as a dermal melanocytic hamartoma that presents as bluish hyperpigmentation along the ophthalmic, maxillary, and mandibular branches of the trigeminal nerve. It is bilateral in less than 5% cases, occurring frequently in Orientals (0.2%-1%) and darker races and rarely in white people (0.04%). Open angle glaucomas and choroidal melanoma are the rare ocular involvements. Ota's naevus is more common in Asians than white people but uveal melanoma occurs predominantly in white populations. 1 2 Dark skinned patients represent only 1% of all cases of orbital melanomas. 3 The risk of developing uveal melanoma in a patient with naevus of Ota is one in 400 patients in their lifetime. 1 2 We report a rare case of bilateral naevus of Ota with a right (RE) choroidal melanoma and left (LE) diffuse pigmentation of retina. Case report A 73 year old Anglo-Indian woman was referred with complaints of photopsia. She had black hair and light brown skin. Examination revealed a brownish-black pigmentation of the conjunctiva, episclera, and periocular skin bilaterally (fig 1). Visual acuity for distance and near was 6/6 and N5, respectively, in each eye. Heterochromia was present, the right iris being a darker brown than the left, which had a sector of light brown colour. Gonioscopy and intraocular pressure were normal. The right fundus revealed a pigmented, large, elevated choroidal mass 10 disc diameter (DD) in size, 4 DD superonasal to the disc. Drusen were overlying it. No subretinal fluid was seen. The left eye showed a patchy dark pigmentation 3 DD in size, at the temporal edge of the macula. A ridge-like pigmented elevation, 3 DD long, was also seen along the superonasal vessels. Both optic discs and maculas were normal. Ultrasound in the right eye showed a 10 mm tumour, 4.2 mm high. Fluorescein angiography confirmed its independent circulation. A systemic examination found no signs of metastasis. A diagnosis of a

Toxic optic neuropathy

“…[1920] This typically occurs after many years of smoking or alcohol abuse. The appearance of the optic nerve is usually normal, but peripapillary dilated vessels and hemorrhages have been described.…”

Alcoholic Optic Neuropathy: Another Complication of Alcohol Abuse

“…[2][3] It is characterized by subacute or gradual loss of central vision, decreased visual acuity, and dyschromatopsia. At the present time, tobacco-alcohol amblyopia is either far less common or is seldom checked for and reported.…”

Estrés oxidativo en la retina de la rata inducido por la administración crónica de etanol: tratamiento con el antioxidante ebselen

“…La pér-dida visual que se produce en muchos alcohólicos se ha englobado generalmente en un cuadro conocido como ambliopía tabaco-alcohólica, atribuyéndo-se un efecto sinérgico del consumo de alcohol con el tabaco, con carencias vitamínicas secundarias a una nutrición deficiente, que conduce a una pérdida en la visión central (19). Además, se ha descrito recientemente que la ambliopía tabaco-alcohólica causa daño a la propia retina y no solamente al nervio óptico (20).…”

“…Esta importante disminución en la amplitud de la onda b concuerda con otro estudio que ha demostrado que los cambios electrorretinográficos en pacientes con ambliopía tabaco-alcohólica se originan generalmente en las capas de células ganglionares y nuclear interna de la retina (20). Nuestros datos sugieren que además del nervio óptico, la propia retina esta afectada por el consumo crónico de etanol.…”