title: Toxic optic neuropathy following ingestion of homeopathic medication Arnica-30.
abstract: We report a case of acute, bilateral and severe vision loss after inadvertent consumption of a large quantity of the homoeopathic medication Arnica-30. Severe vomiting which required hospitalization preceded visual symptoms. In the acute stage, pupillary responses to light were absent and fundus examination was normal. Vision loss followed a fluctuating course, with profound loss noted after 6 weeks along with bilateral optic disc pallor. Neuro-ophthalmic examination and detailed investigations were performed, including magnetic resonance imaging, electroretinography (ERG) and visual evoked potentials (VEP). Ocular coherence tomography (OCT) showed gross thinning of the retinal nerve fiber layer. While a differential diagnosis of posterior ischemic optic neuropathy was kept in mind, these findings supported a diagnosis of bilateral toxic optic neuropathy. Arnica-30 is popularly used to accelerate wound healing, including after oculoplastic surgery. While homeopathic medicines are generally considered safe due to the very low concentrations involved, Arnica-30 may be neurotoxic if consumed internally in large quantities.
authors.affiliation: Sankara Nethralaya, A Unit of Medical Research Foundation, Chennai, India. dev.venkatramani@gmail.com
authors.forename: Devendra V
authors.initials: DV
authors.lastname: Venkatramani
authors.forename: Shubhra
authors.initials: S
authors.lastname: Goel
authors.forename: Vineet
authors.initials: V
authors.lastname: Ratra
authors.forename: Rashmin Anilkumar
authors.initials: RA
authors.lastname: Gandhi
mesh_terms: D019973:Alcohol-Related Disorders / Q000188:drug therapy; D018650:Arnica; D000431:Ethanol / Q000009:adverse effects*; D006396:Hematemesis / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D009902:Optic Neuritis / Q000139:chemically induced*; D008517:Phytotherapy / Q000009:adverse effects; D028321:Plant Preparations / Q000009:adverse effects*; D014786:Vision Disorders / Q000139:chemically induced*
chemical_list: D028321:Plant Preparations; D000431:Ethanol