Methyl-sulfonyl-methane (MSM)-induced acute angle closure.
OBJECTIVE
To report the first case of presumed bilateral acute angle closure (AAC) secondary to ingestion of the dietary supplement, methyl-sulfonyl-methane (MSM).


METHODS
A 35-year-old woman presented with bilateral AAC 1 week after starting multiple dietary supplements, one of which contained MSM. Ultrasound biomicroscopy demonstrated bilateral anterior rotation of the iris-lens diaphragm, ciliary body edema, and choroidal effusion. Four days after discontinuation of the supplements, her angle closure and uveal effusion resolved, and her best-corrected vision recovered to 20/20 bilaterally.


CONCLUSIONS
Sulfa-based drugs have been reported to cause AAC, choroidal effusion, and ciliary body edema. In our patient, the coincidence of bilateral AAC with choroidal and ciliary body effusion that began 1 week after starting dietary supplements was suspicious for drug-induced AAC. The dietary supplement Basic Detox Nutrients contains MSM, the only constituent in the patient's medication list with a sulfonyl moiety. Given the similarities in chemical structure and clinical presentation, we postulate that MSM induces AAC in a manner similar to mechanisms previously described for other sulfa-based drugs.


CONCLUSIONS
As MSM continues to be used and studied for its anti-inflammatory and antioxidative properties, investigators and marketers will need to be cognizant of its potential to cause AAC and provide proper warning to consumers.
*Department of Ophthalmology, USC Keck School of Medicine, Doheny Eye Institute, Los Angeles ‡Retina Vitreous Associates Medical, Beverly Hills, CA †Brody School of Medicine, East Carolina University, Greenville, NC.
Jeremy C
JC
Hwang
Kay T
KT
Khine
Jennifer C
JC
Lee
David S
DS
Boyer
Brian A
BA
Francis
D000208:Acute Disease; D000328:Adult; D000869:Anterior Eye Segment / Q000000981:diagnostic imaging; D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D019587:Dietary Supplements / Q000009:adverse effects*; D004121:Dimethyl Sulfoxide / Q000009:adverse effects*; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007429:Intraocular Pressure; D033401:Microscopy, Acoustic; D013450:Sulfones / Q000009:adverse effects*; D014792:Visual Acuity
D000893:Anti-Inflammatory Agents; D013450:Sulfones; C025910:dimethyl sulfone; D004121:Dimethyl Sulfoxide