Toxic optic neuropathy from alcohol and tobacco


Toxic optic neuropathy from alcohol and tobacco

What is it?

The optic nerve is responsible for transmitting visual information from the eye to the brain. The term optic neuropathy refers to injury or loss of functionality in the optic nerve, which can be the result of multiple causes, such as infections, inflammations, tumors, ischemia (lack of blood supply), trauma, hereditary abnormalities, nutritional deficiencies and toxic substances .

The optic nerve is vulnerable to different toxic substances, including alcohol and tobacco.

Toxic optic neuropathy due to alcohol and tobacco is a rare disease, because it is more associated with pipe or cigar smoking (increasingly obsolete), than with cigarettes. Furthermore, alcoholism is usually associated to nutritional and vitamin deficiency, which contributes to or predisposes further toxicity for the optic nerve. Therefore, alcohol, tobacco and malnutrition act as causal factors of this optic neuropathy.


The main presenting symptom is a painless vision loss, with an insidious onset and slowly progressive. Initially, the patient reports a feeling of central blurriness, followed by a decrease in visual acuity, which can follow a variable evolution. Sometimes it can become very severe. Vision loss is bilateral, although in the early stages it may be asymmetrical, and predominate in one of the two eyes. Also, there is an alteration in the perception of colors (color blindness).

In the examination of the fundus, the appearance of the head of the optic nerve (optic papilla) is usually normal, in most cases at early stages. After a variable time interval, the buds are evolving progressively towards the pale, but total optic atrophy could occur, with permanent visual loss if tobacco and alcohol use is not is not suspended at an early stage. In the examination of the central visual field, central or bilateral defects which are relatively symmetric are usually noted. The color test allows us to confirm the discromatopsia, which dominates the red-green axis. A blood test will be useful to rule out nutritional deficits or vitamin deficiencies. In addition, it allows to exclude the possibility of infection or inflammation as a cause of the alteration of the optic nerve.

Often, one must obtain neuroradiological examinations to rule out a tumor or injury as a result of compressive neuropathy, with MRI still being the test of choice.


Treatment consists of immediate and permanent cessation of tobacco and alcohol use. Thus, gradually recovering and slowly improving the patient’s vision alteration, except if the damage on the optic nerve is severe and/or advanced. A complete and balanced diet with vitamin supplements that contain vitamin B12 is encouraged.


Abuse of alcohol and tobacco, which has multiple harmful effects on the body, can also affect the health of our eyes. Excessive consumption of these toxins can damage the optic nerve and can result in severe vision loss if their consumption at an early stage is not abandoned.



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