A case of localized retinal damage in thallium poisoning

Abstract

Purpose: To determine the cause of visual impairment and to document the late eye disturbances in a case of thallium poisoning.

Patient: A 44-year-old woman presented with a history of repeated attacks of complete alopecia over a period of several months, diffuse pain in both legs, transient gastrointestinal disturbances, abasia with a progressive paraparesis, paresthesia in the fingertips, and polyneuropathy. She complained of slowly progressive visual deterioration in both eyes which began about six months after the first attack of alopecia. The optic discs showed distinct signs of temporal atrophy together with a deep temporal excavation. The Goldmann perimetry revealed an absolute central scotoma. Traces of thallium were found in the urine and in the serum. The district attorney later discovered that her husband had been trying to poison her with thallium.

Methods: The clinical and electrophysiological examinations included visual evoked potentials (VEP) and electroretinography (flash ERG, multifocal ERG and pattern ERG).

Results: The VEP showed a reduction in amplitude and a prolonged latency indicating a conduction block. The pattern ERG was initially normal. At a follow-up examination 6 years later, a slight amplitude reduction in the pattern ERG was found. The multifocal ERG showed a diminished amplitude in the center of the retina (up to +/- 10 degrees visual angle).

Conclusions: The electrophysiological investigations in our patient--who had an optic atrophy--indicated a conduction block of the retinal nerve fibers (VEP) and an additional lesion at or before the retinal bipolar cells (multifocal ERG), localized in the central +/- 10 degrees. These findings suggest that thallium poisoning can lead to a combined lesion of the retinal nerve fibers and the neural retina.