effects side ocular induced-Chemical  • 8 PART  

5.Decreased vision

6.Visual fields

a.Papillomacular scotomas

b.Abnormal static perimetry

c.Abnormal kinetic perimetry

7.Problems with color vision – color vision defect, red-green defect

8.Oscillopsia

9.Lacrimation increased

10. Decreased intraocular pressure – transitory

11. Visual hallucinations

Probable

1.Cataracts

a.Posterior subcapsular

b.Nuclear

Possible

1.Optic nerve

a.Neuritis

b.Temporal pallor

2. Corneal deposits (arcus senilis)

3. Toxic amblyopia

Ocular teratogenic effects (fetal alcohol syndrome)

Certain 

1.Retinal blood vessels – increased tortuosity

2.Decreased vision

3.Optic nerve – hypoplasia

4.Palpebral fissure – horizontal shortening

5.Ptosis

6.Strabismus (convergent or divergent)

7.Abnormalities of anterior chamber angles

8.Secondary glaucoma

9.Duane’s retraction syndrome

10. Cornea

a.Decreased polymegathism

b.Decreased hexagonality

Local ophthalmic use or exposure – retrobulbar injection

Certain

1.Irritation

a.Hyperemia

b.Ocular pain (acute)

c.Edema

2. Keratitis

3. Paralysis of extraocular muscles

4. Nystagmus

5. Ptosis

6. Corneal ulceration

7. Decreased vision

8. Eyelids – depigmentation

9. Ocular anesthesia

Inadvertent ocular exposure

Certain 

1. Irritation

a.Lacrimation

b.Hyperemia

c.Ocular pain

d.Edema

e.Burning sensation 2. Keratitis

3. Corneal necrosis or opacities (prolonged exposure)

Clinical significance

Inadvertent splashes of alcoholic beverage onto the eye surface are a frequent occurrence and result in irritation of the conjunctiva and cornea, but there are no reports of permanent damage. Most distilled alcoholic beverages are 40% alcohol by volume, but concentrations up to 75% are available commercially in the USA. In the photorefractive keratectomy procedure, ophthalmic surgeons use concentrations of less than 40% alcohol to remove corneal epithelium. It has been shown that the duration of application of 20% alcohol is important to corneal epithelial cell survival. A 30-second or less application allows cell survival, while a 60-second application may lead to cell death. There is a report of an adverse event in which alcohol was placed in the anterior chamber during cataract surgery, resulting in permanent endothelial damage.

Consumption of alcoholic beverages leads to a host of wellknown ocular side effects. Acute intoxication may result in nystagmus, a finding used by law enforcement personnel to screen for inebriated motor vehicle operators. Pupil abnormalities, ptosis and strabismus are also well known effects of inebriation. Also reported are temporary corneal clouding, and a methanol-like loss of vision associated with alcohol-induced metabolic acidosis. Alco­ holism also leads to malnutrition in severe cases, which may lead to xerophthalmia or toxic amblyopia. Various types of cataracts have been reported to be more common in heavy users of ethanol, but large population-based studies have shown that nuclear ­sclerosis is more common in people who smoke and drink heavily. It is suspected that alcoholics are also more prone to infectious keratitis. Children born with fetal alcohol syndrome have multiple orbital and ocular structural abnormalities.

Recommendations

1. Inadvertent ocular splashes of high concentrations of ethanol­ should be treated with routine irrigation, and patients­ should be followed for the development of corneal abrasion or ulceration.

2. The ocular side effects of retrobulbar alcohol injections are many, and thus its use in cases of blind and painful eyes should be considered if evisceration or enucleation are not possible.

3. The neuroophthalmic side effects of acute ethanol intoxication­ usually reverse within 24 hours. Chronic use of alcohol will have less untoward ocular effects if the diets are supplemented with vitamins.

References and Further Reading

Al-Faran MF, Al-Omar OM. Retrobulbar alcohol injection in blind painful eyes. Ann Ophthalmol 22: 460–462, 1990.

Dreiss AK, Winkler von Mohrenfels C, Gabler B, et al. Laser epithelial keratomileusis (LASEK): histological investigation for vitality of corneal epithelial cells after alcohol exposure. Klin Monatsbl Augenheilkd

219: 365–369, 2002.

Garber JM. Steep corneal curvature: a fetal alcohol syndrome landmark. J Am Optom Assoc 55: 595–598, 1984.

Hsu HY, Piva A, Sadun AA. Devastating complication from alcohol cauterization­ of recurrent Rathke cleft cyst. Case report. J Neurosurg 100: 1087–1090, 2004.

Kondo M, Ogino N. An accidental irrigation of the anterior chamber with ­ethanol during cataract surgery. Jpn J Clin Ophthalmol 43: 1851–1853, 1989.

Leibowitz HM, Ryan W, Kupferman A, Vitale JJ. The effect of alcohol intoxication on inflammation of the cornea. Arch Ophthalmol 103: 723–725, 1985.

Reisin I, Reisin LH, Aviel E. Corneal melting in a chronic contact lens wearer. CLAO J 22: 146–147, 1996.