Unusual Case of Bilateral Corneal Endothelium and Optic Nerve Atrophy due to a Possible Intoxication by the Insecticide Lambda -Cyhalothrin (Karate 5 CS) in a 58-year-old Vintner: a Case Report

Czech version

Authors: J. Ošmera ¹; D. Dotřelová ¹; J. Mráz ²
Authors‘ workplace: Oční klinika dětí a dospělých 2. LF UK a FN Motol, V Úvalu 84, Praha, 150 ¹; Centrum pracovního lékařství, Státní zdravotní ústav, Šrobárova 48, Praha, 100 ²
Published in: Cesk Slov Neurol N 2007; 70/103(5): 574-579
Category: Case Report

Poděkování: doc. MUDr. Pavlu Urbanovi, CSc., vedoucímu Centra pracovního lékařství Státního zdravotního ústavu, za cenné připomínky k rukopisu. MUDr. Radce Martincové z Oční kliniky 1. LF UK a VFN za pořízení fotodokumentace endotelu rohovek zrcadlovým mikroskopem.

Overview

Authors refer about a case of severe irreversible eye tissues damage after a probable intoxication due to work in vineyard treated the previous day by a mixture of insecticide and fungicide. The 58–year–old patient was treated for rapid painless decrease of visual acuity of both eyes of uncertain etiology. There were observed trophic changes of corneal endothelium and formation of symmetric optic disc swelling that culminated during the first month after the onset of the difficulties. A picture of optic disc and corneal endothelium atrophy developed gradually. In 6 months, the visual acuity was at the level of practical blindness. In diagnostics, a toxic, neurodegenerative or vascular etiology was considered, whereas mitochondropathy or posttraumatical changes were supposed to be less probable. At detailed anamnestic investigation, the only significant event was a work at the vineyard treated with crop-dusting. In toxicological databases we found no effects related to that observed in our patient except a note about the incidence of punctuate foci in cornea in rats exposed to lambda-cyhalothrin. On the basis of ascertained data and complex investigation we expressed an assumption that the anatomical and functional changes in our patient were probably due to an exposure to lambda- cyhalothrin. Even though the cause and mechanism of bilateral corneal endothelium and optic nerve atrophy are presented only as a hypothesis, it is essential to inform about the accident because of severe irreversible anatomical and functional damage to both eyes.

Key words:
toxic optic neuropathy – corneal endothelium atrophy – lambda-cyhalothrin – insecticide

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