DEEP CUPPING OF NERVE HEAD IN ATROPHY OF OPTIC NERVE DUE TO METHYL ALCOHOL

A few of the patients who survive methyl alcohol poisoning subsequently have a type of atrophy of the optic nerve which is accompanied with deep cupping of the disk. The fundus picture is so similar to that associated with glaucoma that when the condition is encountered in practice a great deal of proof is required before deciding against a diagnosis of glaucoma. Fridenberg 1 first described this picture as an entity in 1910, although Moulton 2 mentioned cupping in 1 of his cases in 1901. In the acute stage the disk appears intensely red and is definitely blurred, with extension of the edema to the peripapillary portion of the retina. The swelling increases in prominence ; the color of the disk fades into white. Full and permanent atrophy rapidly follows, featured at times by the remarkable excavation of the nerve head which is so puzzling. No elevation of tension is present. Additional cases were reported by Brown,3 de Schweinitz 5 in the discussion of Fridenberg's paper. In the same year Gruening ° published a description of a similar case, with illustrations of the disks drawn by Fridenberg. There were excavations on both sides, 6 D. in depth. The right disk contained pigmentary traces of a hemorrhage. Cupping has been observed four to four and one-half months after the poisoning.7 1. Fridenberg, P.: Tr. Am. Ophth. Soc. 12:513, 1910. 2. Moulton, H.: A Case of Blindness from Drinking Bay Rum, Compared with the Reported Cases Due to Methyl Alcohol and to Essence of Jamaica Ginger, etc., J. A. M. A. 37:1447 (Nov. 30) 1901.