Optic neuritis secondary to antiandrogen therapy. 2017

Á Ní Mhéalóid, and G Cunniffe
Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland. ainenimhealoid@rcsi.ie.

BACKGROUND Optic neuropathy is a disorder characterised by dysfunction or destruction of the optic nerve tissues. Acquired causes include interruption in the blood supply, nutritional deficiency, compression by a tumour or aneurysm, trauma, and toxic types (Ambizas and Patel In US Pharm 36(4):HS2-HS6, 1). Drug-induced optic neuropathy is of the toxic type and can be defined as a clinical syndrome characterised by papillomacular bundle damage, central, or cecocentral scotoma, and reduced colour vision (Ambizas and Patel In US Pharm 36(4):HS2-HS6, 2011; Sharma and Sharma In Indian J Ophthalmol 59(2):137-141, 2). OBJECTIVE To report a case unilateral optic neuritis, secondary to the use of the antiandrogen, cyproterone acetate. METHODS A 21-year-old female presented with a 4-day history of right brow pain exacerbated by eye movement, and blurring of the right temporal field of vision. She had been taking desogestrel 75 mg and cyproterone acetate 50 mg for the previous 2 months for hormone imbalance. Unaided right visual acuity measured 6/9 and unaided left visual acuity measured 6/6 on Snellen chart. Right red desaturation was present. Goldmann perimetry showed a right enlarged blind spot with predominantly temporal visual field loss. Visually evoked potential (VEP) testing of the right eye showed slightly increased latency, but normal amplitude. Three weeks after discontinuation of the antiandrogen therapy, her symptoms resolved. Repeat Goldmann visual fields showed expansion. CONCLUSIONS Known side-effects of cyproterone acetate include retinal vascular disorder and retinal vein thrombosis, but an association with optic neuritis had not been described to date. There was a temporal relationship between cessation of the medication and improvement in visual symptoms. This implies that discontinuation of the offending drug constitutes the basis of treatment in drug-induced optic neuropathy.

UI MeSH Term Description Entries
D008297 Male Males
D009902 Optic Neuritis Inflammation of the optic nerve. Commonly associated conditions include autoimmune disorders such as MULTIPLE SCLEROSIS, infections, and granulomatous diseases. Clinical features include retro-orbital pain that is aggravated by eye movement, loss of color vision, and contrast sensitivity that may progress to severe visual loss, an afferent pupillary defect (Marcus-Gunn pupil), and in some instances optic disc hyperemia and swelling. Inflammation may occur in the portion of the nerve within the globe (neuropapillitis or anterior optic neuritis) or the portion behind the globe (retrobulbar neuritis or posterior optic neuritis). Neuropapillitis,Retrobulbar Neuritis,Anterior Optic Neuritis,Posterior Optic Neuritis,Anterior Optic Neuritides,Neuritides, Anterior Optic,Neuritides, Optic,Neuritides, Posterior Optic,Neuritides, Retrobulbar,Neuritis, Anterior Optic,Neuritis, Optic,Neuritis, Posterior Optic,Neuritis, Retrobulbar,Neuropapillitides,Optic Neuritides,Optic Neuritides, Anterior,Optic Neuritides, Posterior,Optic Neuritis, Anterior,Optic Neuritis, Posterior,Posterior Optic Neuritides,Retrobulbar Neuritides
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D000726 Androgen Antagonists Compounds which inhibit or antagonize the biosynthesis or actions of androgens. Androgen Antagonist,Antiandrogen,Antiandrogens,Anti-Androgen Effect,Anti-Androgen Effects,Antiandrogen Effect,Antiandrogen Effects,Antagonist, Androgen,Antagonists, Androgen,Anti Androgen Effect,Anti Androgen Effects,Effect, Anti-Androgen,Effect, Antiandrogen,Effects, Anti-Androgen,Effects, Antiandrogen
D014786 Vision Disorders Visual impairments limiting one or more of the basic functions of the eye: visual acuity, dark adaptation, color vision, or peripheral vision. These may result from EYE DISEASES; OPTIC NERVE DISEASES; VISUAL PATHWAY diseases; OCCIPITAL LOBE diseases; OCULAR MOTILITY DISORDERS; and other conditions (From Newell, Ophthalmology: Principles and Concepts, 7th ed, p132). Hemeralopia,Macropsia,Micropsia,Day Blindness,Metamorphopsia,Vision Disability,Visual Disorders,Visual Impairment,Blindness, Day,Disabilities, Vision,Disability, Vision,Disorder, Visual,Disorders, Visual,Hemeralopias,Impairment, Visual,Impairments, Visual,Macropsias,Metamorphopsias,Micropsias,Vision Disabilities,Vision Disorder,Visual Disorder,Visual Impairments
D055815 Young Adult A person between 19 and 24 years of age. Adult, Young,Adults, Young,Young Adults

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