Mla. Sivilotti et al., Reversal of severe methanol-induced visual impairment: No evidence of retinal toxicity due to fomepizole, J TOX-CLIN, 39(6), 2001, pp. 627-631
Case Report: We report a case of methanol poisoning exhibiting complete rec
overy from severe visual impairment following treatment with ethanol, fomep
izole, and hemodialysis. An adult mate presented with central blindness aft
er ingesting methanol. Initial visual acuity was <20/800 (finger counting a
t 1-2 feet) with retinal edema on fundoscopy, arterial pH 7.19, methanol 97
mg/dL (30 mmol/L), formate 14.3 mmol/L, and ethanol undetectable. The pati
ent was treated with ethanol, then fomepizole intravenously (15, 10, then 5
mg/kg), and hemodialysis. Methanol metabolism was effectively blocked by f
omepizole even after ethanol had been eliminated, and the patient recovered
20/20 vision by day, 14 with normal fundoscopy. This case report confirms
highly efficient inhibition of alcohol dehydrogenase by fomepizole, as well
as demonstrate the safety of fomepizole in a patient already, exhibiting e
nd-organ retinal toxicity. The potential for fomepizole to inhibit retinol
dehydrogenase, an isoenzyme of alcohol dehydrogenase essential to vision, d
id not appear to be clinically, significant in this symptomatic methanol-po
isoned patient.