July 1, 2001- Visual Loss After Thioridazine Overdose

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A 29-year-old man was admitted to the emergency department in an unconscious state after ingesting over 1500 mg of thioridazine and a moderate amount of alcohol. Two years earlier, the patient had been maintained on thioridazine, 100 mg/day. He left the hospital the next morning without further assessment.

Eleven days later, he visited a general practitioner complaining of decreased vision since the overdose and was referred to an ophthalmologist. His visual acuity was 3/60 and 2/60 in his right and left eyes, respectively; his pupils were dilated and he had sluggish, minimal reaction to light.

Retinal pigmentation has long been associated with thioridazine. Reports of retinal damage with doses of 1,200 mg daily and above limited the dose to 800 mg daily. This was believed to provide an adequate safety margin. In this case, the overdose was high enough to trigger the acute damage.

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