{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T10:24:15Z","timestamp":1781951055748,"version":"3.54.5"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Toxic optic neuropathy (TON) is characterized by bilateral, symmetric vision loss with damage to the papillomacular bundle, central or cecocentral scotomas, and impaired color vision. While TON has been well-documented with medications such as ethambutol and linezolid, disulfiram-induced optic neuropathy remains rare with limited case reports in the literature.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We report two cases of disulfiram-induced TON in patients with alcohol use disorder. Case 1 involved a 52-year-old man who developed painless, progressive bilateral vision loss after 9\u202fmonths of disulfiram therapy (250\u202fmg daily). Initial visual acuity was 20\/100 OD and 20\/70 OS with severe dyschromatopsia (control plate only bilaterally on Ishihara testing) and central scotomas. Case 2 involved a 55-year-old man with 5\u202fyears of disulfiram use (250\u202fmg daily) who presented with bilateral central vision loss, visual acuity of 20\/50 OD and 20\/40 OS, and marked color vision impairment. Both patients underwent extensive workup including neuroimaging, autoimmune panels, infectious serologies, nutritional markers, heavy metal screening, and genetic testing for hereditary optic neuropathies, all of which were unremarkable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Following disulfiram discontinuation, both patients demonstrated significant visual recovery. In Case 1, visual acuity improved to 20\/40 OD and 20\/30 OS at 7\u202fmonths with normalization of visual fields. In Case 2, visual acuity recovered to 20\/20 bilaterally at 3\u202fmonths with complete restoration of color vision (14\/14 Ishihara plates). Both cases showed persistent temporal retinal nerve fiber layer thinning on optical coherence tomography despite functional recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These cases highlight disulfiram as an important cause of TON in patients with alcohol use disorder. The differential diagnosis in this population must include nutritional and hereditary optic neuropathies, as mitochondrial dysfunction likely represents a common final pathway. Early recognition and drug cessation can result in substantial visual recovery, although structural changes may persist. Clinicians should maintain awareness of this rare but reversible complication when prescribing disulfiram for alcohol dependence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1793252","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T15:39:12Z","timestamp":1776353952000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: Disulfiram-induced optic neuropathy"],"prefix":"10.3389","volume":"17","author":[{"given":"Jo\u00e3o","family":"Mendes","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Hospital do Esp\u00edrito Santo de \u00c9vora","place":["\u00c9vora, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Fischer","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Emory University School of Medicine","place":["Atlanta, GA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter W.","family":"Mortensen","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University of Pittsburgh","place":["Pittsburgh, KS, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjana","family":"Jaiswal","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital","place":["Houston, TX, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Arogundade","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital","place":["Houston, TX, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy J.","family":"Newman","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Emory University School of Medicine","place":["Atlanta, GA, United States"]},{"name":"Department of Neurology, Emory University School of Medicine","place":["Atlanta, GA, United States"]},{"name":"Department of Neurological Surgery, Emory University School of Medicine","place":["Atlanta, GA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew G.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital","place":["Houston, TX, United States"]},{"name":"Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine","place":["Houston, TX, United States"]},{"name":"Department of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine","place":["New York, NY, United States"]},{"name":"Department of Ophthalmology, University of Texas MD Anderson Cancer Center","place":["Houston, TX, United States"]},{"name":"Texas A&M College of Medicine","place":["Bryan, TX, United States"]},{"name":"Department of Ophthalmology, The University of Iowa Hospitals and Clinics","place":["Iowa, IA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1355","DOI":"10.1016\/S1474-4422(16)30237-X","article-title":"Diagnosis and clinical features of common optic neuropathies","volume":"15","author":"Biousse","year":"2016","journal-title":"Lancet Neurol"},{"key":"ref2","first-page":"159","article-title":"Apropos of a further case of optic neuritis due to disulfiram","volume":"66","author":"Perdriel","year":"1966","journal-title":"Bull Soc Ophtalmol Fr"},{"key":"ref3","first-page":"769","article-title":"Optic neuritis caused by disulfiram","volume":"203","author":"Saraux","year":"1970","journal-title":"Ann Ocul (Paris)"},{"key":"ref4","first-page":"1263","article-title":"Disulfiram-induced optic neuritis","volume":"76","author":"Norton","year":"1972","journal-title":"Trans Am Acad Ophthalmol Otolaryngol"},{"key":"ref5","first-page":"779","article-title":"Optic neuritis during treatment with esperal","volume":"74","author":"Maugery","year":"1974","journal-title":"Bull Soc Ophtalmol Fr"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"175","DOI":"10.3109\/01658108808996038","article-title":"Reversible optic neuropathy associated with disulfiram: a clinical and electrophysiological report","volume":"8","author":"Acheson","year":"1988","journal-title":"Neuro-Ophthalmology"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"973","DOI":"10.1016\/0248-8663(96)80822-8","article-title":"Retrobulbar optic neuritis caused by disulfiram (esp\u00e9ral): a case","volume":"16","author":"Geffray","year":"1995","journal-title":"Rev Med Interne"},{"key":"ref8","first-page":"161","article-title":"Optic neuropathy from disulfiram (antabuse): an observation","volume":"268","author":"Guillaume","year":"1998","journal-title":"Bull Soc Belge Ophtalmol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"924","DOI":"10.1016\/S0181-5512(06)70114-0","article-title":"Optic neuropathy while taking disulfiram","volume":"29","author":"Bessero","year":"2006","journal-title":"J Fr Ophtalmol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1007\/s11845-007-0065-3","article-title":"Disulfiram-induced transient optic and peripheral neuropathy: a case report","volume":"176","author":"Orakzai","year":"2007","journal-title":"Ir J Med Sci"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1080\/01658100802590811","article-title":"Disulfiram-induced bilateral optic disc oedema with disc-related visual field loss and sparing of central 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