Detection of Optic Neuropathy and 3-month Follow-up of an Adolescent Inhalant User: Are we Paying Enough Attention?

Sir, Very few centers provide specialty treatment services for adolescent drug users in India. When an adolescent presents with chronic drug use, often the resultant psychosocial complications are assessed in detail, however the physical complications (unless gross or with overt manifestation) are often overlooked in general clinical settings. Inhalant abuse is known to be especially more prevalent among children and adolescents. Toluene, present in many inhaled products, has lipophilic propensity and neurotoxic effects, leading to multifocal brain damage [1] and peripheral neuropathies. However, very few cases of optic neuropathy have been reported. Adolescent inhalant/drug users often have co‑occurring nutritional deficiencies, which may cause or enhance their vulnerability to optic neuropathies. We discuss the case of an adolescent inhalant user, who presented to the specialty clinic at the NDDTC, AIIMS, New Delhi, and though did not have any subjective visual complaints, he was detected to have optic neuropathy, which could later be partially reversed over 3‑month follow‑up. A 14‑year‑old male, school drop‑out, from lower socioeconomic status, presented with regular use of inhalants for 2 years. Inhalant use continued largely uninterrupted (1–2 tubes/day adhesive glue) with no abstinence and was associated with significant psychosocial dysfunction. He also smoked tobacco (10–15 beedis/day) regularly with an occasional use of cannabis for 5 years. There is no significant past or family history. On examination, the patient was thinly built (BMI= 17 kg/sq.m), and pallor was noticed. In routine physical examination, constriction of visual fields was detected on confrontation visual field examination (no subjective complaints). The patient was admitted for further assessment and management with an International Classification of Diseases‑10 diagnosis of tobacco dependence syndrome (F17.2) and volatile solvent dependence syndrome (F18.2). Hemogram and biochemistry tests were within normal limits (except hemoglobin: 9.2 g/dl). Urinalysis did not reveal any opioids, benzodiazepines or cannabis. Intelligence quotient (IQ) assessment yielded a score of 84. Ophthalmological examination revealed mildly sluggish pupillary reactions (visual acuity: right: 6/6, left: 6/9). Fundus showed bilateral (B/L) temporal optic disc pallor. Visual function assessment revealed normal color vision and contrast sensitivity. Humphrey's visual field testing revealed B/L global depression of sensitivity and constricted visual fields [Figure 1]. Findings were indicative of optic neuropathy. No abnormality was detected in otorhinolarygological examination (including pure tone audiometry) and neurological examination. Patient was prescribed an iron supplement, Vitamin B complex, Vitamin C, and coenzyme Q10. Intensive psychosocial interventions were provided and the patient was discharged after a month. …