Choroidal Neovascularization and Toxic Optic Neuropathy Secondary to Tobacco Use: A Case Report

Yasmin Islam,Gibran Khurshid

doi:10.7759/cureus.11493

Abstract

Tobacco and alcohol dependence are known to cause choroidal neovascularization and toxic optic neuropathy, although these typically occur in isolation. In this case report, we describe a 54-year-old male who presented with a juxtafoveal choroidal neovascular membrane (CNVM) in the left eye. Over the course of the next two years, his vision worsened significantly in both eyes, and he developed decreased color vision and paracentral scotomas. Impaired photoreceptor response was detected on full-field electroretinography in both eyes. MRI of the brain and orbits was normal, and laboratory tests for optic neuropathy were within normal limits, except for highly elevated cotinine and nicotine levels. He was in the habit of chewing tobacco nearly constantly, and he admitted to drinking 15-20 alcoholic beverages per week. He was diagnosed with choroidal neovascularization and optic atrophy due to tobacco and alcohol overuse. The effects of tobacco and alcohol use on the health of the choroidal vasculature and optic nerve are discussed in the article.

Highlights

Tobacco and alcohol dependence have adverse effects on the choroidal and retinal vasculature, as well as the function of the optic nerve
We describe a unique patient with both choroidal neovascularization and toxic optic neuropathy incited by overuse of chewing tobacco and alcohol
While the toxic effects of alcohol and tobacco use have been well described in the literature [2,3], to our knowledge, this is the first case demonstrating both choroidal neovascularization and optic neuropathy in the same patient from excessive substance use

Summary

Introduction

Tobacco and alcohol dependence have adverse effects on the choroidal and retinal vasculature, as well as the function of the optic nerve. Using alcohol with tobacco can potentiate each other’s ill effects on ocular functioning [2] In this case report, we describe a unique patient with both choroidal neovascularization and toxic optic neuropathy incited by overuse of chewing tobacco and alcohol. After two years of stability, the patient started to complain of glare and haloes, which correlated with his worsening cataract in the left eye He underwent uncomplicated cataract extraction with intraocular lens implantation in the left eye. He reported heavy alcohol use, with two drinks per day during the weekdays, and two to four drinks of hard liquor daily over the weekend He was diagnosed with toxic optic neuropathy and choroidal neovascularization due to excessive tobacco and alcohol use. He was counseled to decrease his use of toxic substances, and he is currently working with his primary care physician on tobacco and alcohol use reduction

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Disclosures