Contents
Aetiology
Nutritional optic neuropathy (NON):
Nutritional optic neuropathy is usually sporadic; however, it has been described as epidemic during the times of war and/or famine.
- B12-deficiencies (M/C NON)
- Folate deficiencies
- Copper deficiencies
Toxic Optic Neuropathy (TON):
Use of toxic mediacations as well as injestion or inhalation of toxic substances can both cause toxic optic neuropathy.
- CLAIMED
- Chloramphenicol, cyanide (component of tobacco)
- Chronic use of alcohol in heavy smokers (M/C overall)
- Lead
- Aspirin, arsenic, alcohol, amiodarone
- Isoniazid
- Methanol optic neuropathy (acute presentation)
- Ethambutol (antimycobacterial drug)
- Digoxin
- Chloramphenicol, cyanide (component of tobacco)
Clinical features
Toxic and nutritional optic neuropathies both present clinically with symmetric progressive bilateral vision loss, decreased color vision, central or cecocentral scotomas on formal visual field testing, and no relative afferent pupillary defect because of the symmetric nature of optic nerve involvement.
- Diminution of vision: bilaterally symmetrical, painless, gradually progressive
- Dyschromatopsia
Diagnosis
Ophthalmoscopic examination:
- Pupils: sluggish, no RAPD
- Optic disc: normal, swollen, or hyperemic in early stages, temporal optic disc pallor later
- Visual field defect: centrocaecal scotoma