Liquid tobacco-induced optic neuropathy in the tribal population of Northeast India.

PURPOSE: To report TON in indigenous tribal communities of Northeast India, and to explore its association with Tuibur use.

METHOD: Retrospective study undertaken in consecutive patients presenting with unexplained gradual, painless, bilateral diminution of vision. Detailed dietary and medical history was taken. Demographic profile of subjects was noted, including age, gender, ethnicity and occupation. Duration & frequency of Tuibur use per day was noted. Clinical evaluation along with visual fields, color vision, Retinal nerve fibre layer analysis was done. All patients were started on oral Vitamin B complex supplementation, including Vitamin B12 (1500 mcg) once daily for three months. The patients were called for follow up at monthly intervals for 3 months and at 6 months.

RESULT: 39 patients with bilateral involvement, mean age of 39.5 ± 11.6 years were studied. 82% were females; 97.4% belonging to tribal community. There was statistically significant improvement in visual acuity [Oculus Dexter (OD) P=0.002, Oculus Sinister (OS) P=0.007] and visual field indices after treatment.

CONCLUSION

TON may cause severe visual loss; however, timely management gives favourable results. Treatment involves replacing deficient nutrients and eliminating offending toxins. It is also important to consider contributory cultural and dietary practices. This is the first study linking a hitherto unheard-of toxic agent, liquid tobacco (Tuibur/Hidakphu) to optic neuropathy.