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

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.

Keywords: alcohol use disorder; choroidal neovascularization; optic neuropathy; tobacco use disorder.

Figure 1. Macular optical coherence tomography

Macular optical coherence tomography scan of the right eye (OD, top) and left eye (OS, bottom) at presentation. There was outer retinal atrophy and loss of the inner segment/outer segment junction in both eyes (arrowheads), as well as a small amount of intraretinal fluid in the left eye (arrow)