Optic Neuropathy from Vitamin B 12 Deficiency Associated With Alcoholism and Malnutrition

Jong Rak Lee; Yeon-deok Kim; Jin Young Choi; Jaewan Choi

doi:10.3341/jkos.2009.50.6.963

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Lee, Kim, Choi, and Choi: Optic Neuropathy from Vitamin B 12 Deficiency Associated With Alcoholism and Malnutrition

Original Article

J Korean Ophthalmol Soc 2009;50(6):963-967.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.6.963

Optic Neuropathy from Vitamin B ₁₂ Deficiency Associated With Alcoholism and Malnutrition

Jong Rak Lee, MD, Yeon-deok Kim, MD, Jin Young Choi, MD, Jaewan Choi, MD, PhD

Department of Ophthalmology, HanGil Eye Hospital, Incheon, Korea

Address reprint requests to Jaewan Choi, MD, PhD Department of Ophthalmology, HanGil Eye Hospital #543-36 Bupyeong-dong, Bupyeong-gu, Incheon 403-010, Korea Tel: 82-32-503-3322, Fax: 82-32-503-0801, E-mail: deskshot@naver.com

Received 1 December 2008 Accepted 2 March 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report a case of optic neuropathy from vitamin B₁₂ deficiency associated with chronic alcoholism and malnutrition.

Case summary

A 51-year-old man with a complaint of declining visual acuity in both eyes without pain was found to have a temporal optic disc pallor in the left eye. The patient had a history of chronic alcoholism and malnutrition for the previous 7 months. Visual field examination showed central scotoma in both eyes. The vitamin B₁₂ level was undetectable by a blood biochemistry test. Blood dyscrasia such as anemia or thrombocytopenia was not found. The vitamin B₁₂ level became normal after intramuscular cobalamin injections, and visual acuity and visual field tests recovered after 3 months.

Conclusions

Optic neuropathy from vitamin B₁₂ deficiency can be solely present without other systemic manifestations in a patient with chronic alcoholism and malnutrition. Prompt diagnosis by thorough history taking and vitamin B₁₂ supplementation can reverse the disease.

Keywords: Alcoholism, Malnutrition, Optic neuropathy, Vitamin B₁₂ deficiency

References

1. Green PH. Alcohol, nutrition, and malabsorption. Clin Gastroenterol. 1983; 12:563–74.

2. Miller NR. Newman NJ. Walsh and Hoyt's clinical neuro-ophthalmology. 5th ed.Baltimore: Williams and Wilkins;1997. p. 663–79.

3. Chavala SH, Kosmorsky GS, Lee MK, Lee MS. Optic neuropathy in vitamin B12 deficiency. Eur J Intern Med. 2005; 16:447–8.

4. Andrés E, Loukili NH, Noel E, et al. Vitamin B12 (cobalmin) deficiency in elderly patients. CMAJ. 2004; 171:251–9.

5. Allen LH. Causes of vitamin B12 and folate deficiency. Food Nutr Bull. 2008; 29:20–34.

6. Stabler SP, Allen RH, Savage DG, Lindenbaum J. Clinical spectrum and diagnosis of cobalamin deficiency. Blood. 1990; 76:871–81.

7. Hamilton HE, Ellis PP, Sheets RF. Visual impairment due to optic neuropathy in pernicious anemia: Report of a case and review of the literature. Blood. 1959; 14:378–85.

8. Jayle GE, Metge P, Chaix A, et al. Functional exploration of alcohol-tobacco induced optic neuritis. Arch Ophtalmol Rev Gen Ophtalmol. 1972; 32:79–86.

9. Man PY, Turnbull DM, Chinnery PF. Leber hereditary optic neuropathy. J Med Genet. 2002; 39:162–9.

10. Howell N. Leber hereditary optic neuropathy: mitochondrial mutations and degeneration of the optic nerve. Vision Res. 1997; 37:3495–507.

11. Kim J-Y, Hwang JM, Park SS. Mitochondrial DNA C4171A/ND1 is a novel primary causative mutation of Leber's hereditary optic neuropathy with a good prognosis. Ann Neurol. 2002; 51:630–4.

Figure 1.

Humphrey visual field examination at initial presentation reveals central scotoma in both eyes. Mean deviation and pattern standard deviation values were worse in the left eye (B) than in the right eye (A).

Figure 2.

Optic disc photographs at initial presentation. (A) Right eye, (B) Mild temporal pallor is present in the left eye.

Figure 3.

Humphrey visual field examination 3 months after vitamin B₁₂ supplement reveals no scotoma in both eyes (A: right eye, B: left eye).

Figure 4.

Optic disc photographs 3 months after vitamin B₁₂ supplement. There seems to be no difference in the optic disc color between eyes (A: right eye, B: left eye).

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