Tobacco amblyopia

  • Tobacco amblyopia is a toxic amblyopia seen in people who are smoke heavily, consume alcohol and have a diet deficient in proteins and vitamins

Pathogenesis:

  • Cyanide present in tobacco smoke causes degeneration of ganglion cells in the macula
  • There is also degeneration of the papillomacular bundle of nerves

Relation to alcohol consumption:

  • Alcoholics have a dietary deficiency of sulphur rich proteins
  • This results in decreased ability to detoxify cyanide, thus having a synergistic effect

Clinical features:

  • Usually seen in men of 40-60 years of age
  • Visual loss is:
    • gradually progressive
    • painless
    • bilateral
    • affecting central vision (damage to the macula and papillomacular bundle results in centrocecal scotoma)
    • greater defect for red vs white colour
  • Fundus examination reveals a normal fundus (there may be slight temporal pallor of disc)

Treatment:

  • Stop smoking and alcohol intake
  • Intramuscular injections of hydroxycobalamine – 1mg – weekly – for 10 weeks
  • Good nutrition
  • Vasodilators

Prognosis:

  • Good prognosis if there is cessation of smoking and alcohol intake
  • Recovery of vision is slow – takes weeks to months

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