Optic neuropathy associated with copper deficiency after gastric bypass surgery.

Abstract

Patients undergoing gastric bypass procedures are predisposed to many vitamin and mineral deficiencies including copper, which can lead to optic neuropathy. A 35-year-old woman complained of progressive vision loss bilaterally 3 years after gastric bypass surgery (GBS). Ophthalmic examination revealed the presence of subnormal visual acuity and pale optic nerves bilaterally. Laboratory testing showed copper deficiency. Complete improvement in vision was noted after copper was replenished. Nutritional deficiencies occurring after gastric bypass procedures are well reported. They happen and occur due to reduced gastric and enteral absorption and cause many systemic and neurologic manifestations. Optic neuropathy occurring after GBS is often due to vitamin B12 and folic acid deficiency. Copper deficiency causing systemic symptoms is very rare and usually takes decades to manifest. Our case is unique in that copper deficiency was noted as early as 3 years after GBS. Moreover rapid copper replenishment led to a dramatic recovery of vision. Our case underscores the need for maintaining high suspicion when evaluating patients with suspected optic neuropathy occurring after GBS since prompt diagnosis and treatment may lead to reversal of visual loss.