Disulfiram-Induced Optic Neuropathy: Prognostic Factors, Literature Review and Comparison with Alcohol-Tobacco Induced Optic Neuropathy.

Disulfiram is a known cause of toxic optic neuropathy (ON), although there are few cases reported in literature. Our objective is to describe a series of patients with disulfiram-associated ON, and compare them with patients with alcohol-tobacco induced ON. We performed a retrospective cohort of patients with toxic ON, either disulfiram-associated or alcohol-tobacco induced (follow-up: 12 months). Data were extracted from a Spanish tertiary hospital, between 2018 and 2024. Visual acuity (VA) and papillary optic coherence tomography (OCT) were performed at baseline and during the follow-up. A statistical analysis was done, including, Chi-square, Fisher's exact, Mann-Whitney U, and Spearman R tests. Eighteen patients were analyzed (17 males). The mean age of onset was 51.1 years. Seven patients were in active treatment with disulfiram at symptom onset (mean dose received: 204 g). Patients with active disulfiram use had a lower baseline VA (20/77 vs 20/50, p = .049), but this difference equalized at 12 months. Patients that received more than 200 g had a tendency to have a dose-dependent effect (p = .056). Initiation of vitamin therapy suggested a tendency toward visual improvement, whereas cessation of alcohol and withdrawal of disulfiram did not reach statistical significance. Patients with diabetes mellitus did not improve their VA (p = .008). No significant differences in OCT findings were observed between patients with active disulfiram and the rest of patients. In conclusion, most patients with disulfiram-associated ON occurred on middle-age males. Toxicity of disulfiram is probably dose-dependent, and partially reversible after withdrawal. Initiation of vitamin therapy was linked to better visual prognosis.