Unusual Case of Bilateral Corneal Endothelium and Optic Nerve Atrophy due to a Possible Intoxication by the Insecticide Lambda -Cyhalothrin (Karate 5 CS) in a 58-year-old Vintner: a Case Report

Česká verzia

Authors: J. Ošmera ¹; D. Dotřelová ¹; J. Mráz ²
Authors place of work: Oční klinika dětí a dospělých 2. LF UK a FN Motol, V Úvalu 84, Praha, 150 ¹; Centrum pracovního lékařství, Státní zdravotní ústav, Šrobárova 48, Praha, 100 ²
Published in the journal: Cesk Slov Neurol N 2007; 70/103(5): 574-579
Category: Case Report

Poděkování: doc. MUDr. Pavlu Urbanovi, CSc., vedoucímu Centra pracovního lékařství Státního zdravotního ústavu, za cenné připomínky k rukopisu. MUDr. Radce Martincové z Oční kliniky 1. LF UK a VFN za pořízení fotodokumentace endotelu rohovek zrcadlovým mikroskopem.

Summary

Authors refer about a case of severe irreversible eye tissues damage after a probable intoxication due to work in vineyard treated the previous day by a mixture of insecticide and fungicide. The 58–year–old patient was treated for rapid painless decrease of visual acuity of both eyes of uncertain etiology. There were observed trophic changes of corneal endothelium and formation of symmetric optic disc swelling that culminated during the first month after the onset of the difficulties. A picture of optic disc and corneal endothelium atrophy developed gradually. In 6 months, the visual acuity was at the level of practical blindness. In diagnostics, a toxic, neurodegenerative or vascular etiology was considered, whereas mitochondropathy or posttraumatical changes were supposed to be less probable. At detailed anamnestic investigation, the only significant event was a work at the vineyard treated with crop-dusting. In toxicological databases we found no effects related to that observed in our patient except a note about the incidence of punctuate foci in cornea in rats exposed to lambda-cyhalothrin. On the basis of ascertained data and complex investigation we expressed an assumption that the anatomical and functional changes in our patient were probably due to an exposure to lambda- cyhalothrin. Even though the cause and mechanism of bilateral corneal endothelium and optic nerve atrophy are presented only as a hypothesis, it is essential to inform about the accident because of severe irreversible anatomical and functional damage to both eyes.

Key words:
toxic optic neuropathy – corneal endothelium atrophy – lambda-cyhalothrin – insecticide

Zdroje

1. Kesler A, Pianka P. Toxic optic neuropathy. Curr Neurol Neurosci Rep 2003; 3: 410-414.

2. Kerrison JB. Optic neuropathies caused by toxins and adverse drug reactions. Ophthalmol Clin North Am. 2004; 17: 481-488.

3. Otradovec J. Toxické a nutriční neuropatie optiku. In: Otradovec J. Klinická neurooftalmologie. 1. ed. Praha: Grada Publishing; 2003: 191-192.

4. Sadun AA. Metabolic optic neuropathies. Semin Ophthalmol 2002; 17: 29-32.

5. Rucker JC, Hamilton SR, Bardenstein D, Isada CM, Lee MS. Linezolid-associated toxic optic neuropathy. Neurology 2006; 66: 595-598.

6. Melamud A, Kosmorsky GS, Lee MS. Ocular ethambutol toxicity. Mayo Clin Proc 2003; 78: 1409-1411.

7. Ali S, Usman U, Wasay M. Rapidly developing optic neuritis secondary to ethambutol: possible mechanism of injury. J Pak Med Assoc 2005; 55: 300-302.

8. Carelli V, Ross-Cisneros FN, Sadun AA. Mitochondrial dysfunction as a cause of optic neuropathies. Prog Retin Eye Res 2004; 23: 53-89.

9. Yu Wai Man CY, Chinnery PF, Griffiths PG. Optic neuropathies-importance of spatial distribution of mitochondria as well as function. Med Hypotheses 2005; 65: 1038-1042.

10. He F, Wang S, Liu L, Chen S, Zhang Z, Sun J. Clinical manifestations and diagnosis of acute pyrethroid poisoning. Arch Toxicol 1989, 63: 54-58.

11. Woollen BH. Biological monitoring for pesticide absorption. Ann occup Hyg 1993; 37: 525-540.

12. Zoumalan CI, Agarwal M, Sadun AA. Optical coherence tomography can measure axonal loss in patients with ethambutol-induced optic neuropathy. Graefes Arch Clin Exp Ophthalmol 2005; 243: 410-416.