Toxic optic neuropathy is a complex, multifactorial disease potentially affecting individuals of all ages, races, places, and economic strata. Etiology includes nutritional, environmental, toxicologic, and genetic factors. Most cases of nutritional amblyopia are encountered in disadvantaged countries. However, toxic amblyopia related to drug treatment or alcohol abuse is also encountered in the Western world. Typically, toxic and nutritional optic neuropathy is progressive, with bilateral symmetrical painless visual loss causing central or cecocentral scotoma. There is no specific treatment for this disorder. Nevertheless, early detection and prompt management may ameliorate and even prevent severe visual deficit.
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References and Recommended Reading
Lessell S: Toxic and deficiency optic neuropathies. In Walsh & Hoyt’s Clinical Neuro Ophthalmology. Edited by Miller RM, Newman NJ. Baltimore: Williams & Wilkins; 1998:663–679.
Lessell S: Nutritional amblyopia. J Neuro-Ophthalmol 1998, 18:106–111.
Sadun AA: Acquired mitochondrial impairment as a cause of optic nerve disease. Trans Am Ophthalmol Soc 1998, 46:881–923.
Knox DL, Chen MF, Guilarte TR, et al.: Nutritional amblyopia. Retina 1982, 2:288–293.
Biousse V, Newman NJ: Neuro-ophthalmology of mitochondrial diseases. Curr Opin Neurol 2003, 16:35–43.
Eells JT, Henry MM, Lewandowski MF, et al.: Development and characterization of a rodent model of methanol-induced retinal and optic nerve toxicity. Neurotoxicology 2000, 21:321–330.
Hsu HH, Chen CY, Chen FH, et al.: Optic atrophy and cerebral infarcts caused by methanol intoxication: MRI. Neuroradiology 1997, 39:192–194.
Rotestreich Y, Assia E, Kesler A: Late treatment of methanol blindness. Br J Ophthalmol 1997, 81:416–417.
Sharpe JA, Hostovsky M, Bilbao JM, Rewcastle NB: Methanol optic neuropathy: a histological study. Neurology 1982, 32:1093–1100.
Jacobson D, McMartin KE: Methanol and ethylene glycol poisoning. Mechanism of toxicity, clinical course, diagnosis and treatment. Med Toxicol 1986, 1:309–334.
Hwang JM, Kim J, Park SS: Leber’s hereditary optic neuropathy mutations in ethambutol-induced optic neuropathy. J Neurol 2003, 250:87–89.
Heng JE, Vorwerk CK, Lessel E, et al.: Ethambutol is toxic to retinal ganglion cells via an excitotoxic pathway. Invest Ophthalmol Vis Sci 1999, 40:190–196.
Verslegers W, De Deyn PP: Visual impairment due to optic neuropathy in 2 patients on amiodarone, and ethambutol and isoniazide therapy, respectively. Ned Tijdschr Geneeskd 2001, 145:1872.
Feiner LA, Young BR, Kazmier JF, et al.: Optic neuropathy and Amiodarone therapy. Mayo Clin Proc 1987, 62:702–717.
Castells DD, Teitelbaum BA, Tresley DJ: Visual changes secondary to initiation of amiodarone: a case report and review involving ocular management in cardiac polypharmacy. Optometry 2002, 73:113–121.
Baron S, Tyring SK, Fleischmann WR Jr, et al.: The interferon: mechanism of action and clinical application. JAMA 1991, 266:1375–1383.
Purvin VA: Anterior ischemic optic neuropathy secondary to interferon alfa. Arch Ophthalmol 1995, 113:1041–1044.
Noureddin BN, Seoud M, Bashshur Z, et al.: Ocular toxicity in low-dose tamoxifen: a prospective study. Eye 1999, 13:729–733.
Krumesiek J, Kruger C, Patzold U: Tobacco-alcohol amblyopia, neuro-ophthalmological findings and clinical course. Acta Neurol Scand 1985, 72:180–187.
Potts AM: Tobacco amblyopia. Surv Ophthalmol 1973, 17:313–339.
Wilson J: Cyanide in human disease: a review of clinical and laboratory evidence. Fund Appl Toxicol 1983, 3:397–399.
Costagliola C, Rinaldi M, Giacoia A, et al.: Red cell glutathione as a marker of tobacco smoke-induced optic neuropathy. Exp Eye Res 1989, 48:583–586.
Hsu C, Miller T, Wray NR, Misty L: Optic neuropathy from folic acid deficiency without alcohol abuse. Ophthalmologica 2002, 216:65–67.
Sadun A: Acquired mitochondrial impairment as a cause of optic nerve disease. Trans Am Ophthalmol Soc 1998, 96:881–923.
Perez-Stable E: Epidemic neuropathy in Cuba. Ann Intern Med 1995, 123:734.
Caceres TM: Epidemic optic neuropathy in Cuba. Clinical and neurophysiological study. Arch Soc Exp Ophthalmol 2001, 76:493–498.
Gilbert MR: The neurotoxicity of cancer chemotherapy. Neurologist 1998, 4:43–53.
Filley CM, Kleinschmidt-DeMasters BK: Toxic leukoencephalopathy. N Engl J Med 2001, 345:425–432. Important study.
Truwit CL, Denaro CP, Lake JR, DeMarco T: MR imaging of reversible cyclosporin A-induced neurotoxicity. Am J Neuroradiol 1991, 12:651–659.
Harley RD, Huang NN, Macri CH, Green WR: Optic neuritis and optic atrophy following chloramphenicol in cystic fibrosis patients. Trans Am Acad Ophthalmol Otolaryngol 1970, 74:1011–1031.
Shiraki H: Neuropathy due to intoxication with anti-tuberculous drugs from neuropathological view-point. Adv Neuro Sci 1973, 17:120.
Hormes JT, Filley CM, Rosenberg NL, et al.: Neurologic sequelae of chronic solvent vapor abuse. Neurology 1986, 36:698–702.
Gonzalez-Quevedo A, Obregon F, Urbina M, et al.: Effect of chronic methanol administration on amino acids and monoamines in retina, optic nerve, and brain of the rat. Toxicol Appl Pharmacol 2002, 185:77–84.
Carlen PL, Wortzman G, Holgate RC, et al.: Reversible cerebral atrophy in recently abstinent chronic alcoholics measured by computed tomography scans. Science 1978, 200:1076–1078.
Shear PK, Jernigan TL, Butters N: Volumetric magnetic resonance imaging quantification of longitudinal brain changes in abstinent alcoholics. Alcohol Clin Exp Res 1994, 18:172–176.
Pfefferbaum A, Sullivan EV, Hedehus M, et al.: In vivo detection and functional correlates of white matter microstructural disruption in chronic alcoholism. Alcohol Clin Exp Res 2000, 24:1214–1221.
Lancaster FE: Alcohol and white matter development-a review. Alcohol Clin Exp Res 1994, 18:644–647.
Filley CM: Toxic leukoencephalopathy. Clin Neuropharmacol 1999, 22:249–320.
Goebels N, Soyka M: Dementia associated with vitamin B12 deficiency: presentation of two cases and review of the literature. J Neuropsychiatry Clin Neurosci 2000, 12:389–394.
Lindenbaum J, Healton EB, Savage DG, et al.: Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anemia or macrocytosis. N Engl J Med 1988, 318:1720–1728.
Guettat L, Gille M, Delbecq J, Depre A: Folic acid deficiency with leukoencephalopathy and chronic axonal neuropathy of sensory predominance [French]. Rev Neurol (Paris) 1997, 153:351–353.
Adams JW, Bofenkamp TM, Kobrin J, et al.: Recurrent acute toxic optic neuropathy secondary to 5-FU. Cancer Treat Rep 1984, 68:565–566.
Venegas-Francke P, Fruns-Quintana M, Oporto-Caroca M:Bilateral optic neuritis caused by chloramphenicol [Spanish]. Rev Neurol 2000, 15:699–700.
Norton SW, Stockman JA 3rd: Unilateral optic neuropathy following vincristine chemotherapy. J Pediatr Ophthalmol Strabismus 1979, 16:190–193.
Baghadasserian SA: Optic neuropathy due to lead poisoning. Arch Ophthalmol 1968, 80:721–723.
de Letona JM: Optic neuropathy in vitamin B12 deficiency. Lancet 1998, 352:147.
Theodoropoulos DS: Optic neuropathy in vitamin B12 deficiency. Lancet 1998, 352:146–147.
Golnik KC, Schaible ER: Folate-responsive optic neuropathy. J Neuro-Ophthalmol 1994, 14:163–169.
Suzuki S, Kumanomido T, Nagata E, et al.: Optic neuropathy from thiamine deficiency. Intern Med 1997, 36:532.