Tobacco-Alcohol Optic Neuropathy — SCE Neurology MCQ

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ModerateNeuro-ophthalmologyTobacco-Alcohol Optic NeuropathySCE Neurology

A 40-year-old woman presents with painless progressive bilateral visual loss over 6 months. She has bilateral optic atrophy with central scotomata. She smokes 20/day and drinks 40 units/week. B12 is low-normal, folate is low. What is the diagnosis?

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Correct answer: E — Tobacco-alcohol optic neuropathy

Tobacco-alcohol optic neuropathy is a nutritional optic neuropathy from combined toxic and deficiency mechanisms. It presents with bilateral, painless, progressive visual loss with central scotomata. Treatment is abstinence and nutritional supplementation. A: LHON has subacute onset and maternal family history. C: MS optic neuritis is unilateral and painful. D: AION is sudden. E: Compressive neuropathy is unilateral.

Reference: ABN Neuro-ophthalmology Guidelines